1427039098 NPI number — MRS. SUZANNE HICKS GRANTHAM PMHNP APRN BC

Table of content: MRS. SUZANNE HICKS GRANTHAM PMHNP APRN BC (NPI 1427039098)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427039098 NPI number — MRS. SUZANNE HICKS GRANTHAM PMHNP APRN BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRANTHAM
Provider First Name:
SUZANNE
Provider Middle Name:
HICKS
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PMHNP APRN BC
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:
1427039098
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/17/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1101 S CAPITAL OF TEXAS HWY
Provider Second Line Business Mailing Address:
BLDG A SUITE 200
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78746-6400
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-617-6746
Provider Business Mailing Address Fax Number:
512-329-5522

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1101 S CAPITAL OF TEXAS HWY
Provider Second Line Business Practice Location Address:
BLDG A SUITE 200
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78746
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
523-617-6746
Provider Business Practice Location Address Fax Number:
512-329-5522
Provider Enumeration Date:
11/09/2005

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: 363LP0808X , with the licence number:  720359 , 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)





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