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General NPI Number Information
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NPI Number | 1316900624
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Entity Type | Individual
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Provider Name | PATTY HICKS PA
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Gender | Female
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Dates
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Enumeration Date | 04/08/2006
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Last Update Date | 10/11/2007
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Provider Practice Location Address
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Address Line | 2201 S W S YOUNG DR SUITE 111-B
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City | KILLEEN
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State | TX
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Zip | 76543-5317
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Country | US
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Telephone | 254-680-3376
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Fax | 254-680-5252
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Provider Business Mailing Address
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Address Line | 1809 SW H K DODGEN LOOP SUITE 100
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City | TEMPLE
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State | TX
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Zip | 76502-1815
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Country | US
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Telephone | 254-778-5400
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Fax | 254-778-5444
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA01873
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License Number State | TX
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