Provider Demographics
NPI:1982448056
Name:HICKS, GARY JR (DNP-AGNP)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:HICKS
Suffix:JR
Gender:M
Credentials:DNP-AGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 E RED BRIDGE RD STE 207
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131-4030
Mailing Address - Country:US
Mailing Address - Phone:913-681-2398
Mailing Address - Fax:913-681-2416
Practice Address - Street 1:400 E RED BRIDGE RD STE 207
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64131-4030
Practice Address - Country:US
Practice Address - Phone:913-681-2398
Practice Address - Fax:913-681-2416
Is Sole Proprietor?:No
Enumeration Date:2024-06-24
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024022023363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health