Provider Demographics
NPI:1154692176
Name:HICKS, JEANNE ELIZABETH (APRN, AGCNS-BC, LAC)
Entity type:Individual
Prefix:
First Name:JEANNE
Middle Name:ELIZABETH
Last Name:HICKS
Suffix:
Gender:F
Credentials:APRN, AGCNS-BC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1117 SAN AUGUSTINE DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78733-2564
Mailing Address - Country:US
Mailing Address - Phone:512-263-5247
Mailing Address - Fax:
Practice Address - Street 1:711 W 38TH ST STE G2
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1134
Practice Address - Country:US
Practice Address - Phone:512-824-0152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-23
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC00718171100000X
TXAP134746364SA2200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No171100000XOther Service ProvidersAcupuncturist
No364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health