MEDICARE: BRANDI HICKS DNP, NP-C

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	363LF0000X	Family Nurse Practitioner	APN.0994076-NP	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	APN.0994076-NP	OTHER	CO	ADVANCED PRACTICE NURSE LICENSE
2	RXN.0103461-NP	OTHER	CO	NURSE PRACTITIONER RXN LICENSE

General Provider Information

NPI Number	:	1134601149
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDI HICKS DNP, NP-C

Provider Business Mailing Address
First Line	:	7314 ALLENS PARK DR
Second Line	:
City	:	COLO SPGS
State	:	CO
Zip	:	80922-1278
Country	:	US
Telephone Number	:	605-490-2707
Fax Number	:

Provider Business Practice Location Address
First Line	:	4041 E SAN MIGUEL ST
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-3537
Country	:	US
Telephone Number	:	719-344-7846
Fax Number	:

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

Provider Enumeration Date	:	09/06/2018
Last Update Date	:	09/14/2022

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