MEDICARE: MRS. KATHERINE LEIGH HICKS APRN FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	APRN.CNP0030997	OH

General Provider Information

NPI Number	:	1265175533
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATHERINE LEIGH HICKS APRN FNP-C

Provider Business Mailing Address
First Line	:	600 PORTAGE TRL STE A
Second Line	:
City	:	CUYAHOGA FALLS
State	:	OH
Zip	:	44221-3055
Country	:	US
Telephone Number	:	330-808-1664
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 PORTAGE TRL STE A
Second Line	:
City	:	CUYAHOGA FALLS
State	:	OH
Zip	:	44221-3055
Country	:	US
Telephone Number	:	330-808-1664
Fax Number	:	330-208-0378

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/15/2022
Last Update Date	:	06/17/2026

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