MR. SHANNON TROY HICKS (NPI# 1659558005) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1659558005 |
| Entity Type | Individual |
| Full Name | MR. SHANNON TROY HICKS |
| Credential | CTRS |
| Practice Address |
1030 Jefferson Ave Memphis TN 38104-2127 |
| Mailing Address |
7820 Freehold Dr Memphis TN 38125-3254 |
| Practice Telephone | 9015238990 |
| Mailing Telephone | 9015238990 |
| Enumeration Date | 2008-01-29 |
| Last Update Date | 2008-01-29 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 225800000X | Recreation Therapist | 38504 | LA | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871143685 | Shannon Marie Hicks | Nurse Practitioner | 1109 Randolph St, Traverse City, MI 49684-2122 | 2019-09-13 |
| 1417295320 | Shannon Hicks | Counselor | 7136 Gettysburg Pike, Fort Wayne, IN 46804-5680 | 2013-01-28 |
| 1104144286 | Shannon Ashley Hicks | Social Worker | 45 Willow Street, Springfield, MA 01103 | 2010-05-13 |
| 1104944883 | Shannon Camp Hicks | Counselor | 1202 N Stateline, Texarkana, AR 71854-4969 | 2007-03-27 |
| 1154460038 | Shannon Hicks | Speech-Language Pathologist | 10121 Comanche Rd Ne, Mitchell Es, Albuquerque, NM 87111-3614 | 2007-02-06 |
| 1790136901 | Shannon T. Hicks | Pediatrics | 846 Lake Howell Rd, Maitland, FL 32751-5222 | 2016-06-29 |
| 1700131414 | Shannon Miller Hicks | Physical Therapist | 6041 Garners Ferry Rd, Suite B, Columbia, SC 29209-1304 | 2012-07-18 |
| 1679835375 | Shannon Lynn Hicks | Case Manager/Care Coordinator | 721 Highway 46 S, Dickson, TN 37055-2565 | 2012-06-09 |
| 1366691917 | Shannon Kathleen Hicks | Dentist | 800 Zeagler Dr, Suite 330, Palatka, FL 32177-3883 | 2008-09-18 |
| 1275637613 | Shannon Ann Hicks | Counselor | 2750 S 8th St, Beaumont, TX 77701-7719 | 2006-09-07 |
| Street Address |
1030 JEFFERSON AVE |
| City | MEMPHIS |
| State | TN |
| Zip Code | 38104-2127 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982697025 | Katherine Denton Sanford | Optometrist | 1030 Jefferson Ave, Mail Code 112d, Memphis, TN 38104-2127 | 2005-08-24 |
| 1528667938 | Mckenzie Bahl | Recreation Therapist | 1030 Jefferson Ave, Memphis, TN 38104-2127 | 2020-10-19 |
| 1427656834 | Phillip David Resuggan | Music Therapist | 1030 Jefferson Ave, Memphis, TN 38104-2193 | 2020-10-16 |
| 1962009159 | Rachel Diann Roberts | Nurse Anesthetist, Certified Registered | 1030 Jefferson Ave, Memphis, TN 38104-2127 | 2020-10-01 |
| 1225643018 | Melanie Warren | Nurse Practitioner | 1030 Jefferson Ave, Memphis, TN 38104-2127 | 2020-09-09 |
| 1942828892 | Brady Cole | Pharmacist | 1030 Jefferson Ave, Memphis, TN 38104-2127 | 2020-07-08 |
| 1457978595 | Mariko Thel | Pharmacist | 1030 Jefferson Ave, Memphis, TN 38104-2127 | 2020-07-05 |
| 1215554910 | Weston Paul Keen | Pharmacy | 1030 Jefferson Ave, Memphis, TN 38104-2127 | 2020-06-29 |
| 1225655236 | Rebecca Fong | Pharmacist | 1030 Jefferson Ave, Memphis, TN 38104-2127 | 2020-06-26 |
| 1225653660 | Brandy Hollums | Pharmacist | 1030 Jefferson Ave, Memphis, TN 38104-2127 | 2020-06-11 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952900367 | Christy White | Recreation Therapist | 1030 Jefferson Ave (rt117), Memphis, TN 38104 | 2020-10-19 |
| 1821615873 | Altiana Carter | Optometrist | 650 New York St, Memphis, Tn 38104, Memphis, TN 38104 | 2020-06-25 |
| 1952898413 | Family To Family Adult Care Service | Chore Provider | 1331 Union Ave Suite 1028, Mempnis, TN 38104 | 2018-04-19 |
| 1326544800 | Kimberly Vestoria Mcclinton | Nurse Practitioner | 2200 Union Ave 1, Memphis, TN 38104 | 2018-04-03 |
| 1649799339 | Benjamin Duhart Jr. | Pharmacist | 1265 Union Avenue- Methodist University Hospital, Ground Floor Pharmacy Administration, Memphis, TN 38104 | 2017-09-13 |
| 1134644982 | Amy Michelle Wise | Nurse Practitioner | 1325 Eastmoreland Ave Ste 500, Memphis, TN 38104 | 2017-08-13 |
| 1316468572 | Jinger Cathey | Social Worker | 1330 Jefferson Ave, Memphis, TN 38104 | 2017-06-28 |
| 1336669183 | Charma May Kavuncu | Social Worker | 1407 Union Ave Ste 1100, Memphis, TN 38104 | 2017-06-22 |
| 1003345398 | Angelica J Dennis | Nurse Practitioner | 1265 Union, Memphis, TN 38104 | 2017-06-08 |
| 1609302546 | Cheryl Beene | Nurse Practitioner | 1211 Union Ave Ste 475, Memphis, TN 38104 | 2017-05-11 |
| Find all providers in zip 38104 | ||||
| Taxonomy Code | 225800000X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Recreation Therapist |
| A recreation therapist uses recreational activities for intervention in some physical, social or emotional behavior to bring about a desired change in that behavior and promote the growth and development of the patient. |
| Notes: Source: Joel A. DeLisa and Bruce M. Gans, Rehabilitation Medicine: Principles and Practice Second Edition, J.B. Lippincott Company, Philadelphia: 1993, p. 7 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952900367 | Christy White | Recreation Therapist | 1030 Jefferson Ave (rt117), Memphis, TN 38104 | 2020-10-19 |
| 1528667938 | Mckenzie Bahl | Recreation Therapist | 1030 Jefferson Ave, Memphis, TN 38104-2127 | 2020-10-19 |
| 1588980585 | Gail Marie Bacher | Recreation Therapist | 1030 Jefferson Ave, Memphis, TN 38104-2127 | 2010-04-15 |
| 1619153863 | Jason Gerald Minderman | Recreation Therapist | 1030 Jefferson Ave, Suite 117, Memphis, TN 38104-2127 | 2008-01-18 |
| 1720268758 | Walter Gramlin Dupree Jr. | Recreation Therapist | 1030 Jefferson Ave, Memphis, TN 38104-2127 | 2007-11-07 |
| 1992717631 | Esther M. Wipf | Recreation Therapist | 1030 Jefferson Ave, Memphis, TN 38104-2127 | 2006-08-12 |
| 1811925746 | Susan Buntin Matthews | Recreation Therapist | 1030 Jefferson Ave, Memphis, TN 38104-2127 | 2006-06-29 |
| 1437190279 | John Raymond Mikula Jr. | Recreation Therapist | 1030 Jefferson Ave, Memphis, TN 38104-2127 | 2006-06-10 |
| 1073551925 | Peggy J Neil | Recreation Therapist | 1030 Jefferson Ave, Memphis, TN 38104-2127 | 2006-06-03 |
| 1760420426 | Va Medical Center | Recreation Therapist | 1030 Jefferson Ave, (117rt), Memphis, TN 38104-2127 | 2006-06-03 |
| Find all providers in MEMPHIS | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.