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Individual

MR. STACY LAMAR HICKS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PHYSICIAN ASSISTANT

Contact information

Practice address
2401 S 31ST ST, TEMPLE, TX 76508-0001
(254) 724-2111
(254) 724-2111
Mailing address
PO BOX 847556, DALLAS, TX 75284-7556

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
TA60061061
WA
363AS0400X
Surgical Physician Assistant
Primary
PA07805
TX
363AS0400X
Surgical Physician Assistant
TA60061061
WA

Other

Enumeration date
11/14/2008
Last updated
12/28/2021
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