MEDICARE: SAUNDRA MARIE HICKSON MSN, APRN, FNP-BC

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	2022007580	MO

General Provider Information

NPI Number	:	1922755479
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAUNDRA MARIE HICKSON MSN, APRN, FNP-BC

Provider Business Mailing Address
First Line	:	PO BOX 776084
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60677-6084
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1701 LACEY ST
Second Line	:
City	:	CAPE GIRARDEAU
State	:	MO
Zip	:	63701-5230
Country	:	US
Telephone Number	:	573-334-4822
Fax Number	:

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

Provider Enumeration Date	:	03/04/2022
Last Update Date	:	03/06/2026

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