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General NPI Number Information
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NPI Number | 1568014561
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Entity Type | Individual
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Provider Name | GARRETT DOUGLAS HICKS
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Gender | Male
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Dates
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Enumeration Date | 07/10/2019
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Last Update Date | 02/03/2026
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Provider Practice Location Address
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Address Line | 1303 E HERNDON AVE
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City | FRESNO
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State | CA
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Zip | 93720-3309
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Country | US
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Telephone | 559-450-3000
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Fax |
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Provider Business Mailing Address
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Address Line | 4747 N 1ST ST STE 181
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City | FRESNO
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State | CA
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Zip | 93726-0517
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Country | US
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Telephone | 559-978-9154
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 95002812
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95011637
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License Number State | CA
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