Individual
HEATHER KICKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-S
Contact information
Practice address
1061 HARMON AVE, FORT STEWART, GA 31314-5641
(912) 435-6633
Mailing address
1061 HARMON AVE, FORT STEWART, GA 31314-5641
(912) 435-6633
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
01/11/2024
Last updated
07/02/2025
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