Healthcare Provider Details

I. General information

NPI: 1144835653
Provider Name (Legal Business Name): HANNAH FORD HICKEY MS, RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2020
Last Update Date: 09/11/2020
Certification Date: 09/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3167 CUSTER DR STE 301
LEXINGTON KY
40517-4018
US

IV. Provider business mailing address

101 SINGLETON WAY
NICHOLASVILLE KY
40356-9094
US

V. Phone/Fax

Practice location:
  • Phone: 859-388-9152
  • Fax: 859-208-2234
Mailing address:
  • Phone: 859-576-1964
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number260627
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: