Healthcare Provider Details

I. General information

NPI: 1619887940
Provider Name (Legal Business Name): KAILEY HUTCHINS HICKS FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 SERIO BLVD
FERRIDAY LA
71334-2015
US

IV. Provider business mailing address

1704 MERRILL ST
NATCHEZ MS
39120-4029
US

V. Phone/Fax

Practice location:
  • Phone: 318-757-8010
  • Fax:
Mailing address:
  • Phone: 318-757-6551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number908675
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number248740
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: