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NPI Code Detail

MEDICARE: HEATHER LICKE MD

MEDICARE: HEATHER LICKE MD
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
1207Q00000XFamily Medicine Physician7525KS
2207Q00000XFamily Medicine Physician0435055KS

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11093026429OTHERKSBCBS
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1093026429
Entity Type Code : Individual
Provider Name (Legal Business Name) : HEATHER LICKE MD
Provider Business Mailing Address
First Line : 221 W 1ST ST
Second Line :
City : SAINT FRANCIS
State : KS
Zip : 67756-3540
Country : US
Telephone Number : 785-332-2682
Fax Number : 785-332-2516
Provider Business Practice Location Address
First Line : 221 W 1ST ST
Second Line :
City : SAINT FRANCIS
State : KS
Zip : 67756-3540
Country : US
Telephone Number : 785-332-2682
Fax Number : 785-332-2516
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/30/2010
Last Update Date : 05/11/2022

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Directions to “ HEATHER LICKE MD” Practice Location

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