Healthcare Provider Details

I. General information

NPI: 1750237335
Provider Name (Legal Business Name): TALIA HICKS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

329 CONWAY ST
GREENFIELD MA
01301-1521
US

IV. Provider business mailing address

329 CONWAY ST
GREENFIELD MA
01301-1521
US

V. Phone/Fax

Practice location:
  • Phone: 413-774-6301
  • Fax: 866-644-0871
Mailing address:
  • Phone: 413-774-6301
  • Fax: 866-644-0871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA102788
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: