Provider Demographics
NPI:1740331024
Name:HICKS, BRANDI LINETTE (RN, CRNP)
Entity type:Individual
Prefix:MRS
First Name:BRANDI
Middle Name:LINETTE
Last Name:HICKS
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Gender:F
Credentials:RN, CRNP
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Mailing Address - Street 1:47053 AL HIGHWAY 277
Mailing Address - Street 2:SUITE C
Mailing Address - City:BRIDGEPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35740-7205
Mailing Address - Country:US
Mailing Address - Phone:256-437-0555
Mailing Address - Fax:256-437-0404
Practice Address - Street 1:47053 AL HIGHWAY 277
Practice Address - Street 2:SUITE C
Practice Address - City:BRIDGEPORT
Practice Address - State:AL
Practice Address - Zip Code:35740-7205
Practice Address - Country:US
Practice Address - Phone:256-437-0555
Practice Address - Fax:256-437-0404
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2007-07-09
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Provider Licenses
StateLicense IDTaxonomies
AL1-090559363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALQ53434Medicare UPIN