Healthcare Provider Details

I. General information

NPI: 1871003608
Provider Name (Legal Business Name): JAMI LYNN HICKS APRN, CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2017
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1375 N DICKINSON DR
RUSK TX
75785-1051
US

IV. Provider business mailing address

157 WALL ST
TENAHA TX
75974-5413
US

V. Phone/Fax

Practice location:
  • Phone: 903-683-0093
  • Fax: 903-683-0069
Mailing address:
  • Phone: 936-248-4673
  • Fax: 936-248-4646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number20173207
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: