Healthcare Provider Details

I. General information

NPI: 1962973883
Provider Name (Legal Business Name): HAILEY ELIZABETH HICKS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2018
Last Update Date: 12/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 GRAHAM DR STE 200
TOMBALL TX
77375-3346
US

IV. Provider business mailing address

506 GRAHAM DR STE 200
TOMBALL TX
77375-3346
US

V. Phone/Fax

Practice location:
  • Phone: 281-255-3838
  • Fax: 832-698-4231
Mailing address:
  • Phone: 281-255-3838
  • Fax: 832-698-4231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAP138160
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: