Provider Demographics
NPI:1700968518
Name:HICKEY, BRIAN A (APRN BC)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:A
Last Name:HICKEY
Suffix:
Gender:M
Credentials:APRN BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 CENTERVILLE ROAD
Mailing Address - Street 2:SUITE 101 SUMMIT WEST
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886
Mailing Address - Country:US
Mailing Address - Phone:401-732-4500
Mailing Address - Fax:401-732-7766
Practice Address - Street 1:300 CENTERVILLE ROAD
Practice Address - Street 2:SUITE 101 SUMMIT WEST
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886
Practice Address - Country:US
Practice Address - Phone:401-732-4500
Practice Address - Fax:401-732-7766
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRN19583364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI406518OtherBLUE CHIP
RI212652OtherBLUE CROSS BLUE SHIELD
RI406518OtherBLUE CHIP