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Individual
CHARLES W HICKEY
Active
Individual
CHARLES W HICKEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
0024167461
VA
363LF0000X
Family Nurse Practitioner
0024167461
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1700070315
—
VA
05
—
3810009838
—
WV
01
—
P00657227
MEDICARE RR
VA
Enumeration date
08/28/2007
Last updated
12/27/2021
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