Individual
CHARLENE HICKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
70 EDMOND LN, LEAKESVILLE, MS 39451-5706
(601) 394-4135
Mailing address
PO BOX 16285, HATTIESBURG, MS 39404-6285
(601) 318-0669
(601) 994-6001
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
07/10/2026
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