Healthcare Provider Details

I. General information

NPI: 1124362488
Provider Name (Legal Business Name): VICTOR JEROME HICKS JR. APN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/26/2012
Last Update Date: 03/01/2021
Certification Date: 03/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

485 W B ST STE 101
FALLON NV
89406-2765
US

IV. Provider business mailing address

1665 OLD HOT SPRINGS RD STE 157
CARSON CITY NV
89706-0663
US

V. Phone/Fax

Practice location:
  • Phone: 775-423-4434
  • Fax: 775-423-0422
Mailing address:
  • Phone: 775-687-5162
  • Fax: 775-687-5975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN001442
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN001442
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: