Healthcare Provider Details

I. General information

NPI: 1962770677
Provider Name (Legal Business Name): KATIE HICKERSON PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2011
Last Update Date: 12/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8315 GREENBRIER RD
JOELTON TN
37080-8864
US

IV. Provider business mailing address

8315 GREENBRIER RD
JOELTON TN
37080-8864
US

V. Phone/Fax

Practice location:
  • Phone: 615-618-4506
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0000035990
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: