1073796033 NPI number — MRS. SHERRIE DANENE HICKOX PH.D.

Table of content: MRS. SHERRIE DANENE HICKOX PH.D. (NPI 1073796033)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073796033 NPI number — MRS. SHERRIE DANENE HICKOX PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HICKOX
Provider First Name:
SHERRIE
Provider Middle Name:
DANENE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073796033
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/24/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
341 COUNTY ROAD 2234
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DAINGERFIELD
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75638-5467
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-790-1509
Provider Business Mailing Address Fax Number:
903-968-4927

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
377 PR 2014
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GILMER
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75645
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-968-4641
Provider Business Practice Location Address Fax Number:
903-968-4927
Provider Enumeration Date:
12/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  3450 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC0700X , with the licence number: 23450 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 23450 . This is a "LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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