Individual
MS. TYRAH PATRICE HICKMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
3450 HIGHWAY 80 W, JACKSON, MS 39209-7201
(601) 473-6441
Mailing address
1825 S NORRELL RD, BOLTON, MS 39041-3103
(601) 473-6441
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
903798
MS
Other
Enumeration date
03/12/2020
Last updated
03/12/2020
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