Individual
MRS. LACY HICKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CPNP
Contact information
Practice address
2312 KNOB CREEK RD STE 208, JOHNSON CITY, TN 37604-2367
(423) 610-1099
(423) 246-4300
Mailing address
2312 KNOB CREEK RD STE 208, JOHNSON CITY, TN 37604-2367
(423) 610-1099
(423) 246-4300
Taxonomy
Speciality
Code
Description
License number
State
2080P0202X
Pediatric Cardiology Physician
Primary
1841362555
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1376533489
NPI
—
01
—
1578856985
NPI
—
Enumeration date
08/29/2022
Last updated
09/04/2023
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