Provider Demographics
NPI:1457149890
Name:HICKS, JOB N (EMT-P)
Entity type:Individual
Prefix:
First Name:JOB
Middle Name:N
Last Name:HICKS
Suffix:
Gender:
Credentials:EMT-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 DEERFIELD DR
Mailing Address - Street 2:
Mailing Address - City:EASTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01027-9718
Mailing Address - Country:US
Mailing Address - Phone:413-535-6781
Mailing Address - Fax:
Practice Address - Street 1:1 DEERFIELD DR
Practice Address - Street 2:
Practice Address - City:EASTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01027-9718
Practice Address - Country:US
Practice Address - Phone:413-535-6781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-26
Last Update Date:2025-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA335878374700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician