Individual
KERRY HICKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
7163 GOODMAN RD, OLIVE BRANCH, MS 38654-1904
(662) 895-3700
(662) 895-4886
Mailing address
7163 GOODMAN RD, OLIVE BRANCH, MS 38654-1904
(662) 895-3700
(662) 895-4886
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R854092
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09809597
—
MS
05
—
1035971
—
LA
Enumeration date
06/30/2006
Last updated
08/28/2012
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