1124612874 NPI number — ASHLEY MARIA HICKS RDH

Table of content: ASHLEY MARIA HICKS RDH (NPI 1124612874)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124612874 NPI number — ASHLEY MARIA HICKS RDH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HICKS
Provider First Name:
ASHLEY
Provider Middle Name:
MARIA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RDH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HICKS
Provider Other First Name:
ASHLEY
Provider Other Middle Name:
MARIA
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
ASHLEY WEEDEN, RDH
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1124612874
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/23/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18373 E ARKANSAS AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AURORA
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80017-4312
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-370-9898
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
130957 S PARKER RD.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PARKER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80134
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-370-9898
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/23/2021

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: 124Q00000X , with the licence number:  002025918 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: NA , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".