Healthcare Provider Details

I. General information

NPI: 1255074993
Provider Name (Legal Business Name): JOSEPH MAURICE HICKS PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2022
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20254 US HIGHWAY 18
APPLE VALLEY CA
92307-2937
US

IV. Provider business mailing address

PO BOX 74
CARROLLTON VA
23314-0074
US

V. Phone/Fax

Practice location:
  • Phone: 760-483-9444
  • Fax:
Mailing address:
  • Phone: 948-867-3889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95030242
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number0024184166
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024184166
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number0024184166
License Number StateVA
# 5
Primary TaxonomyN
Taxonomy Code364SP0811X
TaxonomyChronically Ill Psychiatric/Mental Health Clinical Nurse Specialist
License Number0024184166
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: