MEDICARE: HOLLY HICKMAN MD

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	390200000X	Student in an Organized Health Care Education/Training Program
2	207V00000X	Obstetrics & Gynecology Physician	DR.0062192	CO

General Provider Information

NPI Number	:	1831586882
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HOLLY HICKMAN MD

Provider Business Mailing Address
First Line	:	16172 HIGHWAY 9
Second Line	:
City	:	BRECKENRIDGE
State	:	CO
Zip	:	80424-8959
Country	:	US
Telephone Number	:	970-423-8840
Fax Number	:

Provider Business Practice Location Address
First Line	:	16172 HIGHWAY 9
Second Line	:
City	:	BRECKENRIDGE
State	:	CO
Zip	:	80424-8959
Country	:	US
Telephone Number	:	731-695-0669
Fax Number	:

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

Provider Enumeration Date	:	04/16/2015
Last Update Date	:	08/29/2022

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Directions to “ HOLLY HICKMAN MD” Practice Location

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