MEDICARE: SHELBY HICKMAN APRN-CRNA

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	367500000X	Certified Registered Nurse Anesthetist	200717	SD

General Provider Information

NPI Number	:	1528990967
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELBY HICKMAN APRN-CRNA

Provider Business Mailing Address
First Line	:	3816 S. INFIELD AVE
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57110
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1305 W. 18TH ST.
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57105
Country	:	US
Telephone Number	:	605-333-1000
Fax Number	:

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

Provider Enumeration Date	:	06/01/2026
Last Update Date	:	06/01/2026

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