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General NPI Number Information
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NPI Number | 1316302946
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Entity Type | Individual
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Provider Name | RYAN MICHAEL HICKEY CRNA
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Gender | Male
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Dates
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Enumeration Date | 12/26/2015
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Last Update Date | 11/10/2021
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Provider Practice Location Address
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Address Line | 805 PAMPLICO HWY
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City | FLORENCE
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State | SC
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Zip | 29505-6047
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Country | US
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Telephone | 843-792-1414
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 603898
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City | CHARLOTTE
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State | NC
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Zip | 28260-3898
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Country | US
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Telephone | 843-792-6200
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN 391011
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | COA 18540-NA
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 24598
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License Number State | SC
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