Provider Demographics
NPI:1548950470
Name:HICKS, WILLIAM R (FNPC)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:R
Last Name:HICKS
Suffix:
Gender:M
Credentials:FNPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5601 S ORCHARD ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-1371
Mailing Address - Country:US
Mailing Address - Phone:532-474-8421
Mailing Address - Fax:
Practice Address - Street 1:BIRCH CREEK POST ACUTE & REHABILITATION 5601 S ORCHARD
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-1371
Practice Address - Country:US
Practice Address - Phone:532-474-8421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-12
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61629489363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily