Hicks, Kerry
Hicks, Kerry is an individual health care provider with primary practice located at 7163 Goodman Rd , Olive Branch MS 38654-1904. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as her primary health care specialty. Hicks, Kerry can be contacted via phone (662) 895-3700.Contact Information
Primary practice address
7163 Goodman Rd
Olive Branch MS 38654-1904
Phone: (662) 895-3700
Fax: (662) 895-4886
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Family | 363LF0000X | R854092 | Mississippi |
Profile Details
| NPI number | 1700815263 |
|---|---|
| LBN Legal business name | Hicks, Kerry |
| Credentials | Nurse Practitioner (NP) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 30th, 2006 |
| Last updated | Aug 28th, 2012 - about 13 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 | 1700815263 | NPPES |
| Mississippi | MEDICAID | 09809597 | |
| Mississippi | MEDICAID | 1035971 |
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