Individual
MR. KEVIN IMMARRI HICKMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1000 E MOUNTAIN DR, WILKES BARRE, PA 18711-0027
(570) 808-7850
(570) 808-7855
Mailing address
100 N ACADEMY AVE, DANVILLE, PA 17822-4903
(570) 808-7850
(570) 808-7855
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
22570531
NY
367500000X
Certified Registered Nurse Anesthetist
Primary
RN810317
PA
Other
Enumeration date
10/04/2011
Last updated
03/09/2026
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