Provider Demographics
NPI:1992061535
Name:BICKHAM, IVONE G (FNP-C)
Entity type:Individual
Prefix:
First Name:IVONE
Middle Name:G
Last Name:BICKHAM
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 E 41ST ST STE 925
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78751-4856
Mailing Address - Country:US
Mailing Address - Phone:512-978-9940
Mailing Address - Fax:512-901-9702
Practice Address - Street 1:1000 E 41ST ST STE 925
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78751-4856
Practice Address - Country:US
Practice Address - Phone:512-978-9940
Practice Address - Fax:512-901-9702
Is Sole Proprietor?:No
Enumeration Date:2012-04-09
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP107932363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily