Healthcare Provider Details

I. General information

NPI: 1881635035
Provider Name (Legal Business Name): KELLY ELISABETH HICKMAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9898 BORROR RD
ORIENT OH
43146-9508
US

IV. Provider business mailing address

9898 BORROR RD
ORIENT OH
43146-9508
US

V. Phone/Fax

Practice location:
  • Phone: 614-877-9070
  • Fax:
Mailing address:
  • Phone: 614-877-9070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN-276609
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: