Provider Demographics
NPI:1316940752
Name:HICKS, JAMES EUGENE (ARNP)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:EUGENE
Last Name:HICKS
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1133 COLLEGE AVE
Mailing Address - Street 2:STE E230
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-2795
Mailing Address - Country:US
Mailing Address - Phone:785-537-4990
Mailing Address - Fax:785-537-1938
Practice Address - Street 1:1133 COLLEGE AVE
Practice Address - Street 2:STE E230
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-2795
Practice Address - Country:US
Practice Address - Phone:785-537-4990
Practice Address - Fax:785-537-1938
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS44928363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSS88357Medicare UPIN
KS160428Medicare ID - Type Unspecified