Healthcare Provider Details

I. General information

NPI: 1871549956
Provider Name (Legal Business Name): LINDA HICKS APN WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 07/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 W BRAKER LANE
AUSTIN TX
78758-3308
US

IV. Provider business mailing address

2115 KRAMER LN SUITE 100
AUSTIN TX
78758-4013
US

V. Phone/Fax

Practice location:
  • Phone: 512-978-9300
  • Fax: 512-279-2556
Mailing address:
  • Phone: 512-978-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAP103890
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: