1992716591 NPI number — MRS. VICKIE LEANN WARREN-HICKS L.P.C

Table of content: MRS. VICKIE LEANN WARREN-HICKS L.P.C (NPI 1992716591)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992716591 NPI number — MRS. VICKIE LEANN WARREN-HICKS L.P.C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WARREN-HICKS
Provider First Name:
VICKIE
Provider Middle Name:
LEANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
L.P.C
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:
1992716591
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/11/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
244 W FM 1606
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HERMLEIGH
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79526-3522
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
325-235-4700
Provider Business Mailing Address Fax Number:
325-235-4781

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1913 7TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SNYDER
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79549-8425
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
325-235-4700
Provider Business Practice Location Address Fax Number:
325-235-4781
Provider Enumeration Date:
08/10/2006

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: 101YM0800X , with the licence number:  16378 , 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: 6774LC . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 141891501 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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