Individual
MATTHEW DAVID HICKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1200 W WALNUT ST, ROGERS, AR 72756-3546
(479) 636-0200
(479) 936-2912
Mailing address
PO BOX 507, LOWELL, AR 72745-0507
(816) 461-8288
(816) 461-6586
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
CO1400
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
150123701
—
AR
05
—
919212001
—
MO
Enumeration date
03/27/2006
Last updated
12/06/2007
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