Healthcare Provider Details

I. General information

NPI: 1780614297
Provider Name (Legal Business Name): JAMES BENFIELD HICKS CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JIMMY HICKS CRNA

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 08/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2460 CURTIS ELLIS DR
ROCKY MOUNT NC
27804-2237
US

IV. Provider business mailing address

2460 CURTIS ELLIS DR
ROCKY MOUNT NC
27804-2237
US

V. Phone/Fax

Practice location:
  • Phone: 252-451-6633
  • Fax: 252-443-8397
Mailing address:
  • Phone: 252-451-6633
  • Fax: 252-443-8397

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number43152
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: