Individual
MR. STACY LAMAR HICKS
Active
Individual
MR. STACY LAMAR HICKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHYSICIAN ASSISTANT
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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