Individual
MR. PATRICK W HICKEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
1541 KINGS HWY, SHREVEPORT, LA 71103
(318) 626-0000
Mailing address
1541 KINGS HWY, ATTN: PAYOR CREDENTIALING, SHREVEPORT, LA 71103-4228
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
0110004808
VA
363A00000X
Physician Assistant
1097209
—
363A00000X
Physician Assistant
Primary
333716
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1710I1002X
INDEPENDANT DUTY CORPSMAN
LA
Enumeration date
11/25/2006
Last updated
07/14/2025
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