Provider Demographics
NPI:1215353651
Name:HICKS, TRACY (APRN, FNP/PMHNP-BC)
Entity type:Individual
Prefix:DR
First Name:TRACY
Middle Name:
Last Name:HICKS
Suffix:
Gender:F
Credentials:APRN, FNP/PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:618 N HIGH ST STE 3
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601-5377
Mailing Address - Country:US
Mailing Address - Phone:903-234-8755
Mailing Address - Fax:
Practice Address - Street 1:618 N HIGH ST STE 3
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-5377
Practice Address - Country:US
Practice Address - Phone:903-234-8755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-10
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX705910363LC1500X
TXAP125290363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily