Provider Demographics
NPI:1063963676
Name:HICKERSON, ASHLEIGH DENA (APRN)
Entity type:Individual
Prefix:
First Name:ASHLEIGH
Middle Name:DENA
Last Name:HICKERSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:ASHLEIGH
Other - Middle Name:DENA
Other - Last Name:LAFFOON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:900 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42431-1644
Mailing Address - Country:US
Mailing Address - Phone:270-875-3502
Mailing Address - Fax:270-825-5551
Practice Address - Street 1:900 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:KY
Practice Address - Zip Code:42431-1644
Practice Address - Country:US
Practice Address - Phone:270-875-3502
Practice Address - Fax:270-825-5551
Is Sole Proprietor?:No
Enumeration Date:2016-10-18
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3010795363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100471580Medicaid
K139260OtherMEDICARE