MEDICARE: CANDIS M HICKS CNM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367A00000X	Advanced Practice Midwife	AP111164	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	842134	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1003972274
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CANDIS M HICKS CNM

Provider Business Mailing Address
First Line	:	1300 W TERRELL AVE STE 320
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-2822
Country	:	US
Telephone Number	:	817-250-7360
Fax Number	:

Provider Business Practice Location Address
First Line	:	1300 W TERRELL AVE STE 320
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-2822
Country	:	US
Telephone Number	:	817-250-7360
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/29/2006
Last Update Date	:	05/17/2021

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Directions to “ CANDIS M HICKS CNM” Practice Location

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