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Individual
MRS. JACQUELINE MICHELE HICKS
Active
Individual
MRS. JACQUELINE MICHELE HICKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
0116020657
VA
207Q00000X
Family Medicine Physician
Primary
2011-00037
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0012104
CIGNA
NC
05
—
1326208117
—
NC
01
—
241298
MEDCOST
NC
01
—
9092685
AETNA
NC
Enumeration date
06/15/2008
Last updated
12/12/2023
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