Provider Demographics
NPI:1740356526
Name:HICKEY, PATRICK W (PA)
Entity type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:W
Last Name:HICKEY
Suffix:
Gender:
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:620 JOHN PAUL JONES CIRCLE
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23700
Mailing Address - Country:US
Mailing Address - Phone:757-953-5008
Mailing Address - Fax:
Practice Address - Street 1:243 CURTISS ROAD, SUITE 100
Practice Address - Street 2:
Practice Address - City:BARKSDALE AFB
Practice Address - State:LA
Practice Address - Zip Code:71110-2425
Practice Address - Country:US
Practice Address - Phone:318-456-5059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-25
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1097209363A00000X
VA0110004808363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1710I1002XOtherINDEPENDANT DUTY CORPSMAN