Individual
JIMMY HICKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
110 HARDIN LN, SOMERSET, KY 42503-3818
(606) 678-3288
Mailing address
425 LEWIS HARGETT CIRCLE, LEXINGTON, KY 40503-3590
(859) 268-1030
(859) 269-4120
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
3360A
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
74007378
—
KY
Enumeration date
08/19/2005
Last updated
10/22/2011
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