Individual
ANGELA CATHERINE HICKMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1314 LAKE ST, FORT WORTH, TX 76102-4581
(817) 810-0660
Mailing address
120 BIRCH ST, WACO, TX 76705-1902
(254) 366-5995
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
805993
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
163WOOOOOX
RN TAXONOMY CODE
TX
01
—
164XOOOOOX
LVN TAXONOMY CODE
TX
Enumeration date
02/23/2018
Last updated
02/23/2018
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