Individual
TARA HICKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
110 PATTON AVE, HATTIESBURG, MS 39401-6155
(601) 582-1111
(605) 450-0765
Mailing address
PO BOX 18679, HATTIESBURG, MS 39404-8679
(601) 705-1901
(601) 705-1952
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
R861341
MS
Other
Enumeration date
02/22/2022
Last updated
02/22/2022
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