Healthcare Provider Details

I. General information

NPI: 1700968518
Provider Name (Legal Business Name): BRIAN A HICKEY APRN BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 CENTERVILLE ROAD SUITE 101 SUMMIT WEST
WARWICK RI
02886
US

IV. Provider business mailing address

300 CENTERVILLE RD STE 101
WARWICK RI
02886-0200
US

V. Phone/Fax

Practice location:
  • Phone: 401-732-4500
  • Fax: 401-732-7766
Mailing address:
  • Phone: 401-732-4500
  • Fax: 401-732-7766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License NumberRN19583
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: