| Doctor Name: | BRANDY T HICKERSON |
| NPI Number: | 1104955202 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MED, PSYCHOLOGIST |
| License Number: | |
| Business Practice Address: | 17 S Central Ave Idabel, OK - 747454625 |
| Business Phone Number: | 5802865184 |
| Business Fax Number: | 5802865185 |
| Mailing Address: | Rr 3 Box 474, BROKEN BOW |
| State: | OK |
| Postal Code: | 747289584 |
| Phone Number: | 5802122726 |
| Fax Number: | |
| NPI Enumeration Date: | 03/05/2007 |
| NPI Last Update Date: | 02/12/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TS0200X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | OK |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | School |
| Taxonomy Definition: | |