Provider Demographics
NPI:1821224635
Name:HICKMAN, RYAN-NIKO (MD)
Entity type:Individual
Prefix:
First Name:RYAN-NIKO
Middle Name:
Last Name:HICKMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 W. CHARLESTON BLVD. STE. 508
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102
Mailing Address - Country:US
Mailing Address - Phone:702-383-2688
Mailing Address - Fax:928-263-5298
Practice Address - Street 1:9320 W. SAHARA AVE.
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117
Practice Address - Country:US
Practice Address - Phone:702-383-3850
Practice Address - Fax:702-562-2816
Is Sole Proprietor?:No
Enumeration Date:2009-06-08
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA321356207QS0010X
AZ56829207Q00000X
SC39988207QS0010X
IL036.128902207QS0010X
NC2011-00129207QS0010X
PAMD482065207QS0010X
MN74809207QS0010X
GA96415207QS0010X
IN01091130A207QS0010X
WI3272-320207QS0010X
MO2023031397207QS0010X
CT077147207QS0010X
NJ25IA12394200207QS0010X
DEC1-0027118207QS0010X
NV19328207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine