| Doctor Name: | VICTOR JEROME HICKS |
| NPI Number: | 1124362488 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | APN |
| License Number: | APN001442 |
| Business Practice Address: | 485 W B St Ste 101 Fallon, NV - 894062765 |
| Business Phone Number: | 7754234434 |
| Business Fax Number: | 7754230422 |
| Mailing Address: | 1665 Old Hot Springs Rd Ste 157, CARSON CITY |
| State: | NV |
| Postal Code: | 897060663 |
| Phone Number: | 7756875162 |
| Fax Number: | 7756875975 |
| NPI Enumeration Date: | 11/26/2012 |
| NPI Last Update Date: | 11/26/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | APN001442 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NV |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |