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General NPI Number Information
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NPI Number | 1457585499
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Entity Type | Individual
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Provider Name | ANDREA Y HICKS M.A.,R.D.N, L.D.
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Gender | Female
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Dates
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Enumeration Date | 05/05/2009
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Last Update Date | 12/15/2019
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Provider Practice Location Address
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Address Line | 1515 NE LAWRIE TATUM RD
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City | LAWTON
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State | OK
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Zip | 73507-3002
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Country | US
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Telephone | 580-354-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 1515 NE LAWRIE TATUM RD
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City | LAWTON
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State | OK
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Zip | 73507-3002
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Country | US
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Telephone | 580-354-5000
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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 | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 1000092
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License Number State |
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 2010
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License Number State | OK
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