MEDICARE: LINDSAY MICHAELA HICKS APRN

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	24140	TN

General Provider Information

NPI Number	:	1134626625
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDSAY MICHAELA HICKS APRN

Provider Business Mailing Address
First Line	:	PO BOX 709
Second Line	:
City	:	SPRING CITY
State	:	TN
Zip	:	37381-0709
Country	:	US
Telephone Number	:	423-452-9984
Fax Number	:	423-452-9980

Provider Business Practice Location Address
First Line	:	126 LAVENDER ST
Second Line	:
City	:	SPRING CITY
State	:	TN
Zip	:	37381-5102
Country	:	US
Telephone Number	:	423-452-9984
Fax Number	:

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

Provider Enumeration Date	:	04/10/2018
Last Update Date	:	05/10/2018

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