Healthcare Provider Details

I. General information

NPI: 1346798485
Provider Name (Legal Business Name): TIFFANY HICKMAN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2016
Last Update Date: 12/09/2020
Certification Date: 12/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 NICHOLASVILLE RD STE 701
LEXINGTON KY
40503-1467
US

IV. Provider business mailing address

1700 NICHOLASVILLE RD STE 701
LEXINGTON KY
40503-1467
US

V. Phone/Fax

Practice location:
  • Phone: 859-278-0396
  • Fax:
Mailing address:
  • Phone: 859-278-0396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number3010398
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: