Individual
CHARLES W HICKEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
1818 AMHERST ST, WINCHESTER, VA 22601-2869
(540) 450-0072
(540) 450-0074
Mailing address
1818 AMHERST ST, WINCHESTER, VA 22601-2869
(540) 450-0072
(540) 450-0074
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
0024167461
VA
363LF0000X
Family Nurse Practitioner
0024167461
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1700070315
—
VA
05
—
3810009838
—
WV
01
—
P00657227
MEDICARE RR
VA
Enumeration date
08/28/2007
Last updated
12/27/2021
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