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NPI Code Detail

MEDICARE: MRS. SHONDELL VANESSA HICKSON APN

MEDICARE: MRS. SHONDELL VANESSA HICKSON APN
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
1363LF0000XFamily Nurse Practitioner14841TN
2364SA2200XAdult Health Clinical Nurse Specialist14841TN

General Provider Information

NPI Number : 1366767550
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SHONDELL VANESSA HICKSON APN
Provider Business Mailing Address
First Line : 230 DOVER ROAD
Second Line :
City : CLARKSVILLE
State : TN
Zip : 37042
Country : US
Telephone Number : 931-920-5000
Fax Number : 931-920-5011
Provider Business Practice Location Address
First Line : 230 DOVER RD
Second Line :
City : CLARKSVILLE
State : TN
Zip : 37042-4183
Country : US
Telephone Number : 931-920-5000
Fax Number : 931-920-5011
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/31/2010
Last Update Date : 03/29/2012

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