Healthcare Provider Details

I. General information

NPI: 1538431002
Provider Name (Legal Business Name): BRITTANY ANNE HICKS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRITTANY ANNE MOODY NP

II. Dates (important events)

Enumeration Date: 01/31/2012
Last Update Date: 05/27/2025
Certification Date: 05/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1340 BROAD AVE STE 330
GULFPORT MS
39501-2464
US

IV. Provider business mailing address

PO BOX 1810
GULFPORT MS
39502-1810
US

V. Phone/Fax

Practice location:
  • Phone: 228-575-1234
  • Fax: 228-867-4828
Mailing address:
  • Phone: 228-575-1800
  • Fax: 228-865-3038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR882745
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number882745
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: