Provider Demographics
NPI:1649718271
Name:HICKMAN, KATHRYN (DNP, CRNA)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:HICKMAN
Suffix:
Gender:F
Credentials:DNP, CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6225 N STATE HIGHWAY 161
Mailing Address - Street 2:SUITE 200
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-2223
Mailing Address - Country:US
Mailing Address - Phone:214-687-0001
Mailing Address - Fax:972-518-2100
Practice Address - Street 1:6225 N STATE HIGHWAY 161
Practice Address - Street 2:SUITE 200
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038-2223
Practice Address - Country:US
Practice Address - Phone:214-687-0001
Practice Address - Fax:972-518-2100
Is Sole Proprietor?:No
Enumeration Date:2017-02-02
Last Update Date:2021-04-02
Deactivation Date:2021-03-29
Deactivation Code:
Reactivation Date:2021-04-02
Provider Licenses
StateLicense IDTaxonomies
TXAP133103367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered