Provider Demographics
NPI:1861808974
Name:HICKMAN, ASHLEY (CPNP)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:HICKMAN
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 S CHURCH ST STE B
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:39601-3232
Mailing Address - Country:US
Mailing Address - Phone:601-990-4028
Mailing Address - Fax:601-990-4029
Practice Address - Street 1:224 S CHURCH ST STE B
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:MS
Practice Address - Zip Code:39601-3232
Practice Address - Country:US
Practice Address - Phone:601-757-2060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-09
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS879993363LP0200X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06607278Medicaid