Healthcare Provider Details

I. General information

NPI: 1952650780
Provider Name (Legal Business Name): KANIKA TASHOUN HICKS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2012
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1147 17TH ST NE APT 4
WASHINGTON DC
20002
US

IV. Provider business mailing address

4021 GANNON RD APT 103
SILVER SPRING MD
20902-1021
US

V. Phone/Fax

Practice location:
  • Phone: 202-423-0096
  • Fax:
Mailing address:
  • Phone: 202-967-7295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number2260628
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: