Individual
JACOB WAYNE HICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2112 NEW HAMPSHIRE AVE NW APT 1007, WASHINGTON, DC 20009-6530
(601) 422-9537
Mailing address
2112 NEW HAMPSHIRE AVE NW APT 1007, WASHINGTON, DC 20009-6530
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
RN1036244
DC
Other
Enumeration date
03/26/2021
Last updated
03/26/2021
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