Healthcare Provider Details

I. General information

NPI: 1447981634
Provider Name (Legal Business Name): TONIKKA HICKS RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TONIKKA MIDGYETT

II. Dates (important events)

Enumeration Date: 06/20/2022
Last Update Date: 06/20/2022
Certification Date: 06/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9038 CROSS PARK DR STE 105
KNOXVILLE TN
37923-4729
US

IV. Provider business mailing address

9038 CROSS PARK DR STE 105
KNOXVILLE TN
37923-4729
US

V. Phone/Fax

Practice location:
  • Phone: 865-394-6612
  • Fax: 865-315-7014
Mailing address:
  • Phone: 865-394-6612
  • Fax: 865-315-7014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-22-217734
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: