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NPI Code Detail

MEDICARE: TAMMY JANE HICKS FNP

MEDICARE: TAMMY JANE HICKS FNP
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
1363LF0000XFamily Nurse PractitionerA005735AR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1821574641
Entity Type Code : Individual
Provider Name (Legal Business Name) : TAMMY JANE HICKS FNP
Provider Business Mailing Address
First Line : PO BOX 497
Second Line :
City : AUGUSTA
State : AR
Zip : 72006-0497
Country : US
Telephone Number : 870-347-2534
Fax Number :
Provider Business Practice Location Address
First Line : 2450 BATESVILLE BLVD
Second Line :
City : BATESVILLE
State : AR
Zip : 72501-7782
Country : US
Telephone Number : 870-569-4934
Fax Number : 870-569-4948
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/15/2018
Last Update Date : 06/24/2019

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Directions to “ TAMMY JANE HICKS FNP” Practice Location

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