Provider Demographics
NPI:1780614297
Name:HICKS, JAMES BENFIELD (CRNA)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:BENFIELD
Last Name:HICKS
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:MR
Other - First Name:JIMMY
Other - Middle Name:
Other - Last Name:HICKS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNA
Mailing Address - Street 1:2460 CURTIS ELLIS DR
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-2237
Mailing Address - Country:US
Mailing Address - Phone:252-451-6633
Mailing Address - Fax:252-443-8397
Practice Address - Street 1:2460 CURTIS ELLIS DR
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-2237
Practice Address - Country:US
Practice Address - Phone:252-451-6633
Practice Address - Fax:252-443-8397
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC43152367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8050161Medicaid
NC430025928Medicare PIN
NC8050161Medicaid
NCP00276463Medicare PIN