Individual
ANGIE D HICKS-MASTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ANP
Contact information
Practice address
920 EAST MEDICAL DRIVE, MANILA, AR 72442
(810) 570-0358
(870) 570-0359
Mailing address
P.O. BOX 717, MANILA, AR 72442
(870) 570-0358
(870) 570-0359
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
A002923
AR
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
APN0000017515
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
17515
TN STATE LICENSE
TN
01
—
2007012778
MO STATE LICENSE
MO
01
—
A002923
AR STATE LICENSE
AR
Enumeration date
11/20/2006
Last updated
05/28/2022
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