Provider Demographics
NPI:1386930808
Name:HICKS, KRISTY RENEE (DO)
Entity type:Individual
Prefix:DR
First Name:KRISTY
Middle Name:RENEE
Last Name:HICKS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:9036 LORTON STATION BLVD
Mailing Address - Street 2:APT# 419
Mailing Address - City:LORTON
Mailing Address - State:VA
Mailing Address - Zip Code:22079-4768
Mailing Address - Country:US
Mailing Address - Phone:570-971-8680
Mailing Address - Fax:
Practice Address - Street 1:9300 DEWITT LOOP
Practice Address - Street 2:
Practice Address - City:FORT BELVOIR
Practice Address - State:VA
Practice Address - Zip Code:22060-5285
Practice Address - Country:US
Practice Address - Phone:571-231-1808
Practice Address - Fax:571-231-1834
Is Sole Proprietor?:No
Enumeration Date:2011-06-22
Last Update Date:2013-07-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0116023948207Q00000X
VA0102203443207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine