Individual
ADRIENE ALISA HICKERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
301 AXIS DR APT 207, LOUISVILLE, KY 40206-0127
(502) 365-0698
Mailing address
301 AXIS DR APT 207, LOUISVILLE, KY 40206-0127
(502) 365-0698
Taxonomy
Speciality
Code
Description
License number
State
3747A0650X
Attendant Care Provider
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
H92436703
3747A0650X
KY
Enumeration date
09/23/2019
Last updated
09/23/2019
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