Healthcare Provider Details

I. General information

NPI: 1235047408
Provider Name (Legal Business Name): LUKE EVAN HICKS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 W RAVINE RD
KINGSPORT TN
37660-3837
US

IV. Provider business mailing address

547 BIG SPRINGS RD
BLUFF CITY TN
37618-2107
US

V. Phone/Fax

Practice location:
  • Phone: 423-224-4000
  • Fax:
Mailing address:
  • Phone: 423-217-7776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number250695
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: