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General NPI Number Information
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NPI Number | 1669451407
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Entity Type | Individual
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Provider Name | EDITH S HICKEY MD
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Gender | Female
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Dates
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Enumeration Date | 01/11/2006
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Last Update Date | 02/09/2023
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Provider Practice Location Address
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Address Line | 225 PHYSICIANS PARK STE 400
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City | POPLAR BLUFF
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State | MO
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Zip | 63901-3923
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Country | US
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Telephone | 573-727-5500
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Fax | 573-727-5599
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Provider Business Mailing Address
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Address Line | PO BOX 801143
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City | KANSAS CITY
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State | MO
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Zip | 64180-1143
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Country | US
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Telephone | 573-331-5583
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Fax | 573-331-5079
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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 | 119635
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License Number State | MO
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