Individual
MISS PAIGE JENNIFER HICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
6100 NEWPORT ROAD, SUITE 100, KALAMAZOO DERMATOLOGY, P.C., PORTAGE, MI 49002-9235
(269) 343-4679
(269) 343-5929
Mailing address
6100 NEWPORT RD STE 100, PORTAGE, MI 49002-9235
(269) 343-4679
(269) 343-5929
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
5601004610
MI
363AM0700X
Medical Physician Assistant
Primary
—
MI
Other
Enumeration date
04/07/2006
Last updated
07/10/2017
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