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General NPI Number Information
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NPI Number | 1407167869
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Entity Type | Individual
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Provider Name | JESSICA ANN HICKS D.O.
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Gender | Female
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Dates
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Enumeration Date | 06/30/2010
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Last Update Date | 06/22/2020
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Provider Practice Location Address
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Address Line | 1001 PENNSYLVANIA AVE
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City | OTTUMWA
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State | IA
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Zip | 52501-6427
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Country | US
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Telephone | 641-684-2530
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Fax |
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Provider Business Mailing Address
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Address Line | 1001 PENNSYLVANIA AVE
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City | OTTUMWA
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State | IA
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Zip | 52501-6427
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Country | US
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Telephone | 641-684-2530
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 5136
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 0116022988
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | DO-04524
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License Number State | IA
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