1629908272 NPI number — MS. KRISTINA NOELLE CECELIA HICKS

Table of content: MS. KRISTINA NOELLE CECELIA HICKS (NPI 1629908272)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629908272 NPI number — MS. KRISTINA NOELLE CECELIA HICKS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HICKS
Provider First Name:
KRISTINA
Provider Middle Name:
NOELLE CECELIA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BONDS
Provider Other First Name:
THOMAS
Provider Other Middle Name:
MARTIN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1629908272
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/22/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3731
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKE WALES
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33859-3731
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
863-280-7578
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
PO BOX 3731
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE WALES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33859-3731
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
863-280-7578
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/22/2026

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: 172A00000X , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 343900000X , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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