MEDICARE: MELONY E HICKS WHCNP

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	363LX0001X	Obstetrics & Gynecology Nurse Practitioner	256312	TX
2	363LW0102X	Women's Health Nurse Practitioner	256312	TX

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	:	1619037058
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELONY E HICKS WHCNP

Provider Business Mailing Address
First Line	:	301 UNIVERSITY BLVD
Second Line	:
City	:	GALVESTON
State	:	TX
Zip	:	77555-5302
Country	:	US
Telephone Number	:	409-772-2222
Fax Number	:

Provider Business Practice Location Address
First Line	:	5819 10TH ST
Second Line	:	SUITE A
City	:	KATY
State	:	TX
Zip	:	77493-1636
Country	:	US
Telephone Number	:	281-391-7001
Fax Number	:	281-391-8175

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

Provider Enumeration Date	:	12/08/2006
Last Update Date	:	06/17/2009

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