Provider Demographics
NPI:1487462461
Name:HICKS, GABRIELLE BETHANY SIERRA ALYSS
Entity type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:BETHANY SIERRA ALYSS
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 1:987 RAINTREE MANSION
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-2113
Mailing Address - Country:US
Mailing Address - Phone:405-702-2098
Mailing Address - Fax:
Practice Address - Street 1:987 RAINTREE MANSION
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-2113
Practice Address - Country:US
Practice Address - Phone:405-702-2098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-23
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist