MEDICARE: MRS. EMILY WANTLAND HICKS FNP-C

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	363LF0000X	Family Nurse Practitioner	AP125863	TX
2	163W00000X	Registered Nurse	755583	TX

General Provider Information

NPI Number	:	1821495813
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. EMILY WANTLAND HICKS FNP-C

Provider Business Mailing Address
First Line	:	3001 BEE CAVES RD STE 210
Second Line	:
City	:	ROLLINGWOOD
State	:	TX
Zip	:	78746-5590
Country	:	US
Telephone Number	:	214-502-9346
Fax Number	:

Provider Business Practice Location Address
First Line	:	3001 BEE CAVES RD STE 210
Second Line	:
City	:	ROLLINGWOOD
State	:	TX
Zip	:	78746-5590
Country	:	US
Telephone Number	:	512-434-0037
Fax Number	:	512-434-0037

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

Provider Enumeration Date	:	11/19/2014
Last Update Date	:	10/08/2025

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