Healthcare Provider Details

I. General information

NPI: 1760178719
Provider Name (Legal Business Name): MAGEN HICKS DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MAGEN ROBINSON DO

II. Dates (important events)

Enumeration Date: 04/13/2023
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 COLLEGE VIEW DR
RIVERTON WY
82501-2289
US

IV. Provider business mailing address

1005 COLLEGE VIEW DR
RIVERTON WY
82501-2289
US

V. Phone/Fax

Practice location:
  • Phone: 307-857-3488
  • Fax:
Mailing address:
  • Phone: 307-857-3488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberW1431
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberTL9199
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: