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General NPI Number Information
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NPI Number | 1245514264
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Entity Type | Individual
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Provider Name | AMANDA C HICKS NP
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Gender | Female
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Dates
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Enumeration Date | 10/10/2011
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Last Update Date | 09/17/2020
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Provider Practice Location Address
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Address Line | 9900 BREN RD E MAIL ROUTE MN 008-B213
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City | MINNETONKA
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State | MN
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Zip | 55343-9664
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Country | US
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Telephone | 830-385-6618
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Fax |
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Provider Business Mailing Address
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Address Line | 5812 OAK CREEK CT
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City | LIPAN
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State | TX
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Zip | 76462-6861
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Country | US
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Telephone | 830-385-6618
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP121105
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 754875
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License Number State | TX
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