Provider Demographics
NPI:1912590969
Name:HICKEY, FARRAR PELL (CRNP)
Entity Type:Individual
Prefix:
First Name:FARRAR
Middle Name:PELL
Last Name:HICKEY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 RAINBOW GLEN CIR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-9517
Mailing Address - Country:US
Mailing Address - Phone:256-348-4165
Mailing Address - Fax:
Practice Address - Street 1:1104 GLENEAGLES DR SW STE A
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-6511
Practice Address - Country:US
Practice Address - Phone:256-801-8987
Practice Address - Fax:256-715-7469
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-19
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-081834363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care