Provider Demographics
NPI:1497592208
Name:HICKS, TIMOTHY LUCAS (CRNP)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:LUCAS
Last Name:HICKS
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1041 INDEPENDENCE CT
Mailing Address - Street 2:
Mailing Address - City:ALABASTER
Mailing Address - State:AL
Mailing Address - Zip Code:35007-9361
Mailing Address - Country:US
Mailing Address - Phone:205-706-3793
Mailing Address - Fax:
Practice Address - Street 1:1932 LAUREL RD STE 1B
Practice Address - Street 2:
Practice Address - City:VESTAVIA HILLS
Practice Address - State:AL
Practice Address - Zip Code:35216-1939
Practice Address - Country:US
Practice Address - Phone:205-421-3420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-09
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-117692363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily