Healthcare Provider Details

I. General information

NPI: 1851754105
Provider Name (Legal Business Name): HICKMAN PSYCHIATRY OF ARIZONA, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2016
Last Update Date: 10/05/2020
Certification Date: 10/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10446 N 74TH ST STE 140
SCOTTSDALE AZ
85258-1045
US

IV. Provider business mailing address

10446 N 74TH ST STE 140
SCOTTSDALE AZ
85258-1045
US

V. Phone/Fax

Practice location:
  • Phone: 602-441-2778
  • Fax: 602-916-0916
Mailing address:
  • Phone: 602-441-2778
  • Fax: 602-916-0916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP5445
License Number StateAZ

VIII. Authorized Official

Name: LAURA ANN HICKMAN
Title or Position: OWNER
Credential: PMHNP-BC
Phone: 602-441-2778