Provider Demographics
NPI:1740877281
Name:HICKS, BETTY YOUNT (LRD, RN, LLC)
Entity type:Individual
Prefix:
First Name:BETTY
Middle Name:YOUNT
Last Name:HICKS
Suffix:
Gender:F
Credentials:LRD, RN, LLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 BLANDINA CT
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-6433
Mailing Address - Country:US
Mailing Address - Phone:704-984-0646
Mailing Address - Fax:
Practice Address - Street 1:130 BLANDINA CT
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-6433
Practice Address - Country:US
Practice Address - Phone:704-984-0646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-30
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC98322163WC0400X, 163WD0400X
803661133V00000X, 133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, RenalGroup - Multi-Specialty
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes EducatorGroup - Multi-Specialty
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered