Individual
MRS. LISA M HICKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP
Contact information
Practice address
126 CLINIC DR, DOTHAN, AL 36303-1980
(334) 793-1881
(334) 340-5918
Mailing address
126 CLINIC DR, DOTHAN, AL 36303-1980
(334) 793-1881
(334) 340-5918
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
1-109237
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
196555
—
AL
Enumeration date
03/23/2012
Last updated
07/06/2017
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