Doctor Name: | RANDALL S HICKS |
NPI Number: | 1760726699 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | APRN |
License Number: | 111716 |
Business Practice Address: | 2501 Capehart Rd Offutt Afb, NE - 681131043 |
Business Phone Number: | 4022946033 |
Business Fax Number: | |
Mailing Address: | 2501 Capehart Rd, OFFUTT AFB |
State: | NE |
Postal Code: | 681131043 |
Phone Number: | 4022946033 |
Fax Number: | |
NPI Enumeration Date: | 11/15/2012 |
NPI Last Update Date: | 08/20/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 111716 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NE |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |