Healthcare Provider Details

I. General information

NPI: 1245403161
Provider Name (Legal Business Name): JASON T HICKS APRN, LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2008
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 FRANKLIN RD
MONTICELLO KY
42633-2245
US

IV. Provider business mailing address

PO BOX 969
SOMERSET KY
42502-0969
US

V. Phone/Fax

Practice location:
  • Phone: 606-396-3534
  • Fax: 606-396-3535
Mailing address:
  • Phone: 606-425-5768
  • Fax: 606-425-5769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3008758
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2011
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: