Healthcare Provider Details

I. General information

NPI: 1922934728
Provider Name (Legal Business Name): SIMIRRIA HICKS RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 AIRWAYS BLVD
SOUTHAVEN MS
38671-5839
US

IV. Provider business mailing address

7300 AIRWAYS BLVD
SOUTHAVEN MS
38671-5839
US

V. Phone/Fax

Practice location:
  • Phone: 662-448-3232
  • Fax: 662-490-3723
Mailing address:
  • Phone: 662-448-3232
  • Fax: 662-490-3723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-544594
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: