Provider Demographics
NPI:1154964930
Name:HICKS, SHYLISA (NP)
Entity type:Individual
Prefix:
First Name:SHYLISA
Middle Name:
Last Name:HICKS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20403 FM 529 RD STE 200
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-5379
Mailing Address - Country:US
Mailing Address - Phone:281-656-4041
Mailing Address - Fax:
Practice Address - Street 1:20403 FM 529 RD STE 200
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-5379
Practice Address - Country:US
Practice Address - Phone:281-656-4041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-23
Last Update Date:2024-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX929193163WN0002X
TX1088788208000000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care
No208000000XAllopathic & Osteopathic PhysiciansPediatrics