Provider Demographics
NPI:1316347701
Name:HICKS, VICTORIA WRIGHT (PA-C)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:WRIGHT
Last Name:HICKS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 344
Mailing Address - Street 2:732 ELIZAVILLE RD
Mailing Address - City:FLEMINGSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41041-0344
Mailing Address - Country:US
Mailing Address - Phone:606-849-2323
Mailing Address - Fax:606-849-2025
Practice Address - Street 1:732 ELIZAVILLE AVE
Practice Address - Street 2:
Practice Address - City:FLEMINGSBURG
Practice Address - State:KY
Practice Address - Zip Code:41041-1139
Practice Address - Country:US
Practice Address - Phone:606-849-2323
Practice Address - Fax:606-849-2025
Is Sole Proprietor?:No
Enumeration Date:2014-09-04
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KYTC309363A00000X
KYPA1956363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant