MEDICARE: NICOLE A HICKS PA

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	363A00000X	Physician Assistant	PA15089	CA

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

General Provider Information

NPI Number	:	1427067495
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE A HICKS PA

Provider Business Mailing Address
First Line	:	130 INDEPENDENCE CIR
Second Line	:	SUITE 1
City	:	CHICO
State	:	CA
Zip	:	95973-4962
Country	:	US
Telephone Number	:	530-343-5864
Fax Number	:	530-343-6106

Provider Business Practice Location Address
First Line	:	130 INDEPENDENCE CIR
Second Line	:	SUITE 1
City	:	CHICO
State	:	CA
Zip	:	95973-4962
Country	:	US
Telephone Number	:	530-343-5864
Fax Number	:	530-343-6106

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

Provider Enumeration Date	:	08/07/2006
Last Update Date	:	11/08/2016

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Practice Location Address:

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Directions to “ NICOLE A HICKS PA” Practice Location

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