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General NPI Number Information
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NPI Number | 1366608051
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Entity Type | Organization
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Legal Business Name | JESSIE D. HICKS, D.O.,P.A.
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Dates
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Enumeration Date | 08/01/2008
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Last Update Date | 08/01/2008
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Provider Practice Location Address
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Address Line | 4301 COLLEGE DR RM 800
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City | VERNON
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State | TX
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Zip | 76384-3128
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Country | US
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Telephone | 940-552-9323
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Fax | 940-552-9328
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Provider Business Mailing Address
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Address Line | 4301 COLLEGE DR RM 800
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City | VERNON
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State | TX
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Zip | 76384-3128
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Country | US
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Telephone | 940-552-9323
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Fax | 940-552-9328
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | DR. JESSIE DENEICE HICKS
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Credential | D.O.
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Telephone | 940-552-9323
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | K6864
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License Number State | TX
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