Healthcare Provider Details

I. General information

NPI: 1568014561
Provider Name (Legal Business Name): GARRETT DOUGLAS HICKS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2019
Last Update Date: 02/03/2026
Certification Date: 02/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1303 E HERNDON AVE
FRESNO CA
93720-3309
US

IV. Provider business mailing address

4747 N 1ST ST STE 181
FRESNO CA
93726-0517
US

V. Phone/Fax

Practice location:
  • Phone: 559-450-3000
  • Fax:
Mailing address:
  • Phone: 559-978-9154
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number95002812
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95011637
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: