Provider Demographics
NPI:1336410562
Name:HICKS, BRITTANY MICHELE
Entity type:Individual
Prefix:MISS
First Name:BRITTANY
Middle Name:MICHELE
Last Name:HICKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2445 W BROOK RIDGE ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65803-8086
Mailing Address - Country:US
Mailing Address - Phone:417-718-6352
Mailing Address - Fax:
Practice Address - Street 1:2445 W BROOK RIDGE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65803-8086
Practice Address - Country:US
Practice Address - Phone:417-718-6352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-19
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered