Healthcare Provider Details

I. General information

NPI: 1851379218
Provider Name (Legal Business Name): ROBIN L HICKERSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2006
Last Update Date: 03/09/2020
Certification Date: 03/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 E SEVIER ST
BENTON AR
72015-3934
US

IV. Provider business mailing address

307 E SEVIER ST
BENTON AR
72015-3934
US

V. Phone/Fax

Practice location:
  • Phone: 501-315-4224
  • Fax: 501-778-0450
Mailing address:
  • Phone: 501-315-4224
  • Fax: 501-778-0450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberG6424
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberC-6423
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: