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NPI Code Detail

MEDICARE: BREANNA NICOLE HICKENBOTTOM

MEDICARE: BREANNA NICOLE HICKENBOTTOM
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
1106S00000XBehavior TechnicianAZ

General Provider Information

NPI Number : 1851224588
Entity Type Code : Individual
Provider Name (Legal Business Name) : BREANNA NICOLE HICKENBOTTOM
Provider Business Mailing Address
First Line : 110 W BELL RD APT 230
Second Line :
City : PHOENIX
State : AZ
Zip : 85023-7493
Country : US
Telephone Number : 331-229-6068
Fax Number :
Provider Business Practice Location Address
First Line : 20601 N 19TH AVE STE 100
Second Line :
City : PHOENIX
State : AZ
Zip : 85027-2666
Country : US
Telephone Number : 888-754-0398
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/03/2026
Last Update Date : 06/03/2026

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Directions to “ BREANNA NICOLE HICKENBOTTOM ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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