Provider Demographics
NPI:1720088164
Name:HICKMAN, PATRICIA L (NP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:L
Last Name:HICKMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1306 E 7TH ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:AUBURN
Mailing Address - State:IN
Mailing Address - Zip Code:46706-2536
Mailing Address - Country:US
Mailing Address - Phone:260-925-0666
Mailing Address - Fax:260-925-0669
Practice Address - Street 1:1306 E 7TH ST
Practice Address - Street 2:SUITE C
Practice Address - City:AUBURN
Practice Address - State:IN
Practice Address - Zip Code:46706-2537
Practice Address - Country:US
Practice Address - Phone:260-925-0666
Practice Address - Fax:260-925-0669
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-28
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000715363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200178800AMedicaid
INS90504Medicare UPIN
INTB1540Medicare PIN