Individual
TYSON HICKLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
250 HOSPITAL PL, SOLDOTNA, AK 99669-7559
(907) 714-4502
(907) 714-4696
Mailing address
5955 ZEAMER AVE # 673MDG, JBER, AK 99506-3702
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
0116028145
VA
207P00000X
Emergency Medicine Physician
Primary
MD61440052
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1699522
—
AK
Enumeration date
04/03/2014
Last updated
10/20/2023
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