Provider Demographics
NPI:1548015530
Name:HICKEM, TIAUNA
Entity type:Individual
Prefix:
First Name:TIAUNA
Middle Name:
Last Name:HICKEM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 AUSTIN AVE STE 208
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-4294
Mailing Address - Country:US
Mailing Address - Phone:573-321-9803
Mailing Address - Fax:
Practice Address - Street 1:206 AUSTIN AVE STE 208
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-4294
Practice Address - Country:US
Practice Address - Phone:573-321-9803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No372600000XNursing Service Related ProvidersAdult Companion
No376J00000XNursing Service Related ProvidersHomemaker