Hicks, Jessie D
Hicks, Jessie D is an individual health care provider with primary practice located at 1500 S Main St , Fort Worth TX 76104-4917. She recently has only one registered license in Allopathic & Osteopathic Physicians / Internal Medicine, which is considered as her primary health care specialty. Hicks, Jessie D can be contacted via phone (817) 702-1100.Contact Information
Primary practice address
1500 S Main St
Fort Worth TX 76104-4917
Phone: (817) 702-1100
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | K6864 | Texas |
Profile Details
| NPI number | 1811994023 |
|---|---|
| LBN Legal business name | Hicks, Jessie D |
| Credentials | Doctor of Osteopathy (DO) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 1st, 2005 |
| Last updated | Jun 7th, 2023 - about 2 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1811994023 | NPPES |
| Texas | MEDICAID | 030891903 | |
| Texas | MEDICAID | 030891801 | |
| Texas | Other | 0028DT | |
| Texas | Other | 8BQ007 | |
| Texas | MEDICAID | 030891813 | |
| Texas | Other | 110243367 |
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