Individual
CHARLENE HICKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
404 MAIN STREET, NEW AUGUSTA, MS 39462
(601) 964-8391
(601) 964-8393
Mailing address
PO BOX 1729, HATTIESBURG, MS 39403-1729
(601) 545-8700
(601) 450-2493
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
901452
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03437726
—
MS
01
—
697484
MEDICARE PIN
MS
Enumeration date
03/01/2016
Last updated
04/04/2019
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