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General NPI Number Information
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NPI Number | 1245735943
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Entity Type | Individual
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Provider Name | JACQUELINE HICKS
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Gender | Female
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Dates
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Enumeration Date | 03/26/2018
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Last Update Date | 11/23/2020
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Provider Practice Location Address
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Address Line | 284 HIGHWAY 641 N
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City | CAMDEN
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State | TN
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Zip | 38320-1350
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Country | US
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Telephone | 731-213-2446
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Fax | 731-213-2447
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Provider Business Mailing Address
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Address Line | 284 HIGHWAY 641 N
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City | CAMDEN
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State | TN
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Zip | 38320-1350
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Country | US
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Telephone | 731-213-2446
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Fax | 731-213-2447
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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 | 23945
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 0000023945
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License Number State | TN
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