Healthcare Provider Details

I. General information

NPI: 1033522073
Provider Name (Legal Business Name): AUBRI BAILEY HICKMAN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2014
Last Update Date: 11/29/2021
Certification Date: 11/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 W WOODROW AVE
JACKSON MS
39213-7681
US

IV. Provider business mailing address

504 CLINTON CENTER DRIVE CBO - SUITE 4300
CLINTON MS
39056
US

V. Phone/Fax

Practice location:
  • Phone: 601-815-1212
  • Fax: 601-815-3123
Mailing address:
  • Phone: 601-815-1212
  • Fax: 601-815-3123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR884256
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: