MEDICARE: VIKKI JO HICKS

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	164X00000X	Licensed Vocational Nurse	137317	TX

General Provider Information

NPI Number	:	1679052286
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIKKI JO HICKS

Provider Business Mailing Address
First Line	:	1004 TUDOR DR
Second Line	:
City	:	AMARILLO
State	:	TX
Zip	:	79104-3314
Country	:	US
Telephone Number	:	806-471-1590
Fax Number	:

Provider Business Practice Location Address
First Line	:	1004 TUDOR DR
Second Line	:
City	:	AMARILLO
State	:	TX
Zip	:	79104-3314
Country	:	US
Telephone Number	:	806-471-1590
Fax Number	:

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

Provider Enumeration Date	:	08/14/2018
Last Update Date	:	08/14/2018

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