Organization
HICKS HOME-BASED PRIMARY CARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WANDA DENISE HICKS FNP, DNP (CEO AND FOUNDER)
(251) 408-7568
Entity
Organization
Contact information
Practice address
1111 E I65 SERVICE RD S STE 210, MOBILE, AL 36606-3123
(251) 408-7568
Mailing address
1111 E I65 SERVICE RD S STE 210, MOBILE, AL 36606-3123
(251) 408-7568
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1033206545
BC/BS
AL
05
—
1033206545
—
AL
Enumeration date
11/14/2019
Last updated
03/31/2022
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