Healthcare Provider Details

I. General information

NPI: 1053373506
Provider Name (Legal Business Name): JOAN MARIE HICKS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 POPLAR GROVE CONNECTOR SUITE B
BOONE NC
28607-5915
US

IV. Provider business mailing address

132 POPLAR GROVE CONNECTOR SUITE B
BOONE NC
28607-5915
US

V. Phone/Fax

Practice location:
  • Phone: 828-264-8759
  • Fax: 828-262-5687
Mailing address:
  • Phone: 828-264-8759
  • Fax: 828-262-5687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number067714
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: