Provider Demographics
NPI:1396717823
Name:HICKS, DOROTHY E (PA)
Entity type:Individual
Prefix:
First Name:DOROTHY
Middle Name:E
Last Name:HICKS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:DOTTIE
Other - Middle Name:E
Other - Last Name:SCHENK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:503 W COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-5311
Mailing Address - Country:US
Mailing Address - Phone:256-767-1779
Mailing Address - Fax:256-767-1780
Practice Address - Street 1:503 W COLLEGE ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-5311
Practice Address - Country:US
Practice Address - Phone:256-767-1779
Practice Address - Fax:256-767-1780
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9819363A00000X
ALPA.1504363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN560079100Medicaid