Individual
KEVIN LEE HICKEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
ONE MEDICAL VILLAGE DRIVE, INDEPENDENT ANESTHESIOLOGISTS PSC, EDGEWOOD, KY 41017
(859) 341-7246
(859) 341-7867
Mailing address
PO BOX 12749, INDEPENDENT ANESTHESIOLOGISTS PSC, COVINGTON, KY 41012-0749
(859) 341-7246
(859) 341-7867
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
1090399
KY
163W00000X
Registered Nurse
262060
OH
367500000X
Certified Registered Nurse Anesthetist
Primary
079098
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000547667
ANTHEM
—
05
—
200890500
—
IN
05
—
2833812
—
OH
05
—
7100032860
—
KY
01
—
9492557
PHCS
—
Enumeration date
01/08/2008
Last updated
07/31/2008
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