Healthcare Provider Details

I. General information

NPI: 1174988828
Provider Name (Legal Business Name): CAITLIN HICKOK RN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/23/2015
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 6TH AVE SW
RONAN MT
59864-2600
US

IV. Provider business mailing address

2819 GREAT NORTHERN LOOP
MISSOULA MT
59808-1750
US

V. Phone/Fax

Practice location:
  • Phone: 406-676-3600
  • Fax: 406-676-3738
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN250202
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN250202
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number160707
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: