Healthcare Provider Details

I. General information

NPI: 1578428173
Provider Name (Legal Business Name): ANNA HICKS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

744 W 9TH ST
TULSA OK
74127-9907
US

IV. Provider business mailing address

744 W 9TH ST
TULSA OK
74127-9907
US

V. Phone/Fax

Practice location:
  • Phone: 918-599-5823
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2962
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: