Healthcare Provider Details

I. General information

NPI: 1215849211
Provider Name (Legal Business Name): HICKS HEALTH MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1781 N OLD WIRE RD
FAYETTEVILLE AR
72703-3016
US

IV. Provider business mailing address

1781 N OLD WIRE RD
FAYETTEVILLE AR
72703-3016
US

V. Phone/Fax

Practice location:
  • Phone: 939-996-9413
  • Fax:
Mailing address:
  • Phone: 939-996-9413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: PATRICIA A JOHNSON
Title or Position: MANAGER
Credential:
Phone: 939-996-9413