MEDICARE: LATIA MICHELLE HICKERSON WHNP

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	363L00000X	Nurse Practitioner	794027	TX
2	207V00000X	Obstetrics & Gynecology Physician	794027	TX
3	363L00000X	Nurse Practitioner	AP122845	TX

General Provider Information

NPI Number	:	1811238652
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LATIA MICHELLE HICKERSON WHNP

Provider Business Mailing Address
First Line	:	17000 EL CAMINO REAL STE 204A
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77058-2636
Country	:	US
Telephone Number	:	832-284-4328
Fax Number	:	832-219-8303

Provider Business Practice Location Address
First Line	:	17000 EL CAMINO REAL STE 204A
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77058-2636
Country	:	US
Telephone Number	:	832-284-4328
Fax Number	:	832-219-8303

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

Provider Enumeration Date	:	03/04/2013
Last Update Date	:	04/14/2026

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