Doctor Name: | KIMBERLY R HICKMAN |
NPI Number: | 1134310824 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | CNP |
License Number: | COA 09489 |
Business Practice Address: | 1019 Keith Dr Perry, GA - 310694951 |
Business Phone Number: | 4789888556 |
Business Fax Number: | |
Mailing Address: | 603 Stirling Bridge Dr, WARNER ROBINS |
State: | GA |
Postal Code: | 310881110 |
Phone Number: | 7407515516 |
Fax Number: | |
NPI Enumeration Date: | 08/07/2007 |
NPI Last Update Date: | 11/05/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | COA 09489 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | OH |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |