Provider Demographics
NPI:1699328765
Name:HICKMAN, KRISTIN RENAE (APRN)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:RENAE
Last Name:HICKMAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:RENAE
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:121 NEWPORT TOWNE CTR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37821-7391
Mailing Address - Country:US
Mailing Address - Phone:423-532-8621
Mailing Address - Fax:423-532-8704
Practice Address - Street 1:121 NEWPORT TOWNE CTR
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:TN
Practice Address - Zip Code:37821-7391
Practice Address - Country:US
Practice Address - Phone:423-532-8621
Practice Address - Fax:423-532-8704
Is Sole Proprietor?:No
Enumeration Date:2019-07-18
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11700377363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily