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NPI Code Detail

MEDICARE: KRISTEN KELLEY HICKS MS RD LD

MEDICARE: KRISTEN KELLEY HICKS MS RD LD
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
1133V00000XRegistered Dietitian86006909TX

General Provider Information

NPI Number : 1336572262
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTEN KELLEY HICKS MS RD LD
Provider Business Mailing Address
First Line : PO BOX 2238
Second Line :
City : BRYAN
State : TX
Zip : 77806-2238
Country : US
Telephone Number : 800-203-8657
Fax Number :
Provider Business Practice Location Address
First Line : 108 PARK PL
Second Line :
City : CAMP HILL
State : PA
Zip : 17011-7222
Country : US
Telephone Number : 800-203-8657
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/14/2013
Last Update Date : 02/24/2016

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