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General NPI Number Information
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NPI Number | 1710627641
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Entity Type | Individual
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Provider Name | BENJAMIN HICKS DO
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Gender | Male
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Dates
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Enumeration Date | 03/30/2022
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Last Update Date | 02/13/2025
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Provider Practice Location Address
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Address Line | 2908 HAWKINS DR
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City | SEARCY
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State | AR
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Zip | 72143-4802
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Country | US
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Telephone | 501-278-3201
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Fax |
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Provider Business Mailing Address
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Address Line | 115 COUNTY ROAD 122
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City | BONO
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State | AR
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Zip | 72416-8606
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Country | US
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Telephone |
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | E18439
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License Number State | AR
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