Provider Demographics
NPI:1144835653
Name:HICKEY, HANNAH FORD (MS, RD)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:FORD
Last Name:HICKEY
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 SINGLETON WAY
Mailing Address - Street 2:
Mailing Address - City:NICHOLASVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40356-9094
Mailing Address - Country:US
Mailing Address - Phone:859-576-1964
Mailing Address - Fax:
Practice Address - Street 1:3167 CUSTER DR STE 301
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40517-4018
Practice Address - Country:US
Practice Address - Phone:859-388-9152
Practice Address - Fax:859-208-2234
Is Sole Proprietor?:No
Enumeration Date:2020-09-11
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133NN1002X
KY260627133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education