=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578241709
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAUREN E HICKMAN FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/07/2023
-----------------------------------------------------
Last Update Date | 08/25/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11130 KINGSTON PIKE STE 7&8
-----------------------------------------------------
City | FARRAGUT
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37934-2865
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-675-1953
-----------------------------------------------------
Fax | 833-908-2090
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 26194
-----------------------------------------------------
City | BELFAST
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04915-2012
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 833-908-0990
-----------------------------------------------------
Fax | 833-908-0998
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 34096
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------