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General NPI Number Information
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NPI Number | 1811238652
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Entity Type | Individual
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Provider Name | LATIA MICHELLE HICKERSON WHNP
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Gender | Female
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Dates
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Enumeration Date | 03/04/2013
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Last Update Date | 04/14/2026
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Provider Practice Location Address
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Address Line | 17000 EL CAMINO REAL STE 204A
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City | HOUSTON
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State | TX
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Zip | 77058-2636
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Country | US
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Telephone | 832-284-4328
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Fax | 832-219-8303
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Provider Business Mailing Address
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Address Line | 17000 EL CAMINO REAL STE 204A
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City | HOUSTON
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State | TX
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Zip | 77058-2636
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Country | US
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Telephone | 832-284-4328
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Fax | 832-219-8303
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 794027
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 794027
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | AP122845
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License Number State | TX
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