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NPI Code Detail

MEDICARE: KYLE DOUGLAS HICKS

MEDICARE: KYLE DOUGLAS HICKS
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
1163WC0200XCritical Care Medicine Registered Nurse95069170CA
2367500000XCertified Registered Nurse Anesthetist95069170CA
3363LF0000XFamily Nurse Practitioner95022187CA

General Provider Information

NPI Number : 1700647542
Entity Type Code : Individual
Provider Name (Legal Business Name) : KYLE DOUGLAS HICKS
Provider Business Mailing Address
First Line : 3222 EVERGLADE AVE # A
Second Line :
City : CLOVIS
State : CA
Zip : 93619-9586
Country : US
Telephone Number : 559-999-0660
Fax Number :
Provider Business Practice Location Address
First Line : 20 E RIVER PARK PL W
Second Line :
City : FRESNO
State : CA
Zip : 93720-1551
Country : US
Telephone Number : 559-256-4950
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/18/2024
Last Update Date : 01/18/2024

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Directions to “ KYLE DOUGLAS HICKS ” Practice Location

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