Provider Demographics
NPI:1669069381
Name:HICKS, LINDA JEAN (RN,FNP)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:JEAN
Last Name:HICKS
Suffix:
Gender:F
Credentials:RN,FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 N CRUTCHFIELD ST # 2
Mailing Address - Street 2:
Mailing Address - City:DOBSON
Mailing Address - State:NC
Mailing Address - Zip Code:27017-8804
Mailing Address - Country:US
Mailing Address - Phone:888-789-2922
Mailing Address - Fax:336-789-4334
Practice Address - Street 1:105 N CRUTCHFIELD ST # 2
Practice Address - Street 2:
Practice Address - City:DOBSON
Practice Address - State:NC
Practice Address - Zip Code:27017-8804
Practice Address - Country:US
Practice Address - Phone:888-789-2922
Practice Address - Fax:336-789-4334
Is Sole Proprietor?:No
Enumeration Date:2020-12-29
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001263586163WG0000X
NC201374163WG0000X
NC5013962363L00000X, 363LF0000X
VA0024188193363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5013962OtherNCBON