Basic Information
| Provider Information | |||||||||
| NPI: | 1851962567 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KRISTIN L HICKS MD PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 405 SE COCONUT AVE | ||||||||
| Address2: | |||||||||
| City: | STUART | ||||||||
| State: | FL | ||||||||
| PostalCode: | 349962547 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 613 SW CAMDEN AVE | ||||||||
| Address2: | |||||||||
| City: | STUART | ||||||||
| State: | FL | ||||||||
| PostalCode: | 349942924 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7723499304 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2021 | ||||||||
| LastUpdateDate: | 07/03/2021 | ||||||||
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| AuthorizedOfficialLastName: | HICKS | ||||||||
| AuthorizedOfficialFirstName: | KRISTIN | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2162884994 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 07/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.