Healthcare Provider Details

I. General information

NPI: 1942138649
Provider Name (Legal Business Name): MICHAEL JAMES HICKLE PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6355 LAUREL PARK
HUBBARD OH
44425-1334
US

IV. Provider business mailing address

6355 LAUREL PARK
HUBBARD OH
44425-1334
US

V. Phone/Fax

Practice location:
  • Phone: 330-398-4243
  • Fax:
Mailing address:
  • Phone: 330-398-4243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.0042157
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: