MEDICARE: SHAWLAWN FREEMAN-HICKS PMHNP-BC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	0024178682	VA

General Provider Information

NPI Number	:	1598305906
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAWLAWN FREEMAN-HICKS PMHNP-BC

Provider Business Mailing Address
First Line	:	2400 SANDLER CT
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23235-6368
Country	:	US
Telephone Number	:	804-944-5057
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 SOUTHLAKE BLVD STE J
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23236-3061
Country	:	US
Telephone Number	:	804-944-5057
Fax Number	:

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

Provider Enumeration Date	:	01/14/2020
Last Update Date	:	09/16/2024

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