Individual
BRADLEY SMITH HICKMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2392 ADDISON AVE E, TWIN FALLS, ID 83301-6745
(307) 548-5200
Mailing address
2945 RUBY DR, TWIN FALLS, ID 83301-5632
(208) 212-1173
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-2529
ID
Other
Enumeration date
10/11/2017
Last updated
03/05/2024
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