HICKS HOME-BASED PRIMARY CARE, LLC (NPI# 1679118525) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1679118525 |
| Entity Type | Organization |
| Organization Name | HICKS HOME-BASED PRIMARY CARE, LLC |
| Practice Address |
1111 E I65 Service Rd S Ste 210 Mobile AL 36606-3123 |
| Practice Telephone | 2514087568 |
| Mailing Telephone | 2514087568 |
| Enumeration Date | 2019-11-14 |
| Last Update Date | 2019-11-14 |
| Authorized Official Name | DR. WANDA DENISE HICKS (CEO AND FOUNDER) |
| Authorized Official Telephone | 2514087568 |
| Authorized Official Credential | FNP, DNP |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AL | UNITED HEALTH | 1033206545 | 01 |
| AL | 1033206545 | 05 | |
| AL | BC/BS | 1033206545 | 01 |
| AL | PRIVATE INSURANCES | 1033206545 | 01 |
| Street Address |
1111 E I65 SERVICE RD S STE 210 |
| City | MOBILE |
| State | AL |
| Zip Code | 36606-3123 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982216388 | Kaitlyn Culotta Dozier | Student in an Organized Health Care Education/Training Program | 936 Grant Park Drive, Mobile, AL 36606 | 2020-08-18 |
| 1902466758 | Gulf Coast Totalcare | Case Management | 3280 Dauphin Street, Building C, Suite 1, Mobile, AL 36606 | 2019-06-14 |
| 1023581246 | Elizabeth Fair | Psychologist | 3168 Midtown Park S Ste E, Mobile, AL 36606 | 2019-01-10 |
| 1962987420 | Asra Bashir | Pharmacist | 101 East Interstate 65 Service Rd S, Mobile, AL 36606 | 2018-10-01 |
| 1902398274 | Tunisia London | Social Worker | 601 Bel Air Blvd Ste 411, Mobile, AL 36606 | 2018-06-03 |
| 1962925677 | Tasheka Janine Scott I | Nurse's Aide | 629 Crenshaw Street, Mobile, AL 36606 | 2017-07-25 |
| 1295128189 | Costco Wholesale Corporation | Eyewear Supplier (Equipment, not the service) | 1450 Tingle Circle West, Mobile, AL 36606 | 2015-03-17 |
| 1437441623 | Julia Marco Williams | Counselor | 605 Bel Air Blvd Ste 33, Mobile, AL 36606 | 2011-05-06 |
| 1235363516 | Jenny M Neese | Dietitian, Registered | 2504 Dauphin Street, Suite J, Mobile, AL 36606 | 2009-05-14 |
| 1609000223 | Bay Area Nutrition, Inc | Dietitian, Registered | 2029-b Airport Blvd, Suite 195, Mobile, AL 36606 | 2009-05-11 |
| Find all providers in zip 36606 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083222145 | Robert Adam Vickrey | Nurse Practitioner | 1718 Hunters Ridge Dr W, Mobile, AL 36695-9246 | 2020-07-15 |
| 1588286850 | Brandie Nicole Banks | Nurse Practitioner | 320 Stanton Rd Apt 1517, Mobile, AL 36617-2481 | 2020-05-10 |
| 1215569249 | Lisa K. Morris | Nurse Practitioner | 5721 Usa Drive North Hahn 2044, Mobile, AL 36688-0001 | 2020-02-07 |
| 1417504325 | Jamie Kathryn Turner | Nurse Practitioner | 13080 Oak Forge Dr, Mobile, AL 36608-8782 | 2019-08-25 |
| 1780142653 | Melissa Snow Bryan | Nurse Practitioner | 4937 Langham Pl, Mobile, AL 36619-5201 | 2019-03-08 |
| 1508322231 | Akiko Ishida Makino | Nurse Practitioner | 75 S University Blvd # 6000a, Mobile, AL 36608-3042 | 2019-02-19 |
| 1932674975 | Justin Blake Stokes | Nurse Practitioner | 2050 Michigan Ave., Mobile, AL 36615 | 2018-10-05 |
| 1821590647 | Charleen Jackson | Nurse Practitioner | 2423 Schillinger Rd S Ste 103, Mobile, AL 36695-4142 | 2018-03-07 |
| 1265949200 | Jennifer Jennings Davis | Nurse Practitioner | 2451 Fillingim Street Suite 10-i, Mobile, AL 36617-2293 | 2017-12-29 |
| 1770093882 | Alisa Lucero Johnston | Nurse Practitioner | 6280 Grelot Rd, Mobile, AL 36609-3614 | 2017-10-03 |
| Find all providers in MOBILE | ||||
Please comment or provide details below to improve the information on HICKS HOME-BASED PRIMARY CARE, LLC.
| 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.