Provider Demographics
NPI:1912111964
Name:HICKS, AMY CABLE
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:CABLE
Last Name:HICKS
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:AMY
Other - Middle Name:BETH
Other - Last Name:CABLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5578 SHANNON HEIGHTS BLVD
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-4185
Mailing Address - Country:US
Mailing Address - Phone:614-356-3341
Mailing Address - Fax:
Practice Address - Street 1:5578 SHANNON HEIGHTS BLVD
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43016-4185
Practice Address - Country:US
Practice Address - Phone:614-356-3341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor