Katelyn Hicks, ARNP
Individual provider Active NPI Family Nurse Practitioner · Chipley, FL
NPI 1104347004 · NPPES record last updated Jun 29, 2017
Key facts
- NPI
- 1104347004
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- ARNP9363859 (FL)
- Practice address
- 1360 Brickyard Rd
Chipley, FL 32428-6303 - Phone
- (850) 638-1610
- NPI assigned
- Jun 29, 2017
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 9
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2017
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Mid-South Palliative Services LLC
Calhoun-Liberty Hospital Association Inc
Practice addresses (Care Compare)
Pensacola, FL 32504
Phone (850) 316-4882
16257 State Rd 71
Blountstown, FL 32424-2808
Phone (850) 674-5411
Hospital & facility affiliations
- Northwest Florida Community Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170821002799 | FL | Practitioner - Nurse Practitioner | 2466724711 | Reassigns benefits to 6 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Calhoun-Liberty Hospital Association Inc | Current |
Accepting new patients | |
| Southland Hospitlalist at Chipley, PL. | Current |
Accepting new patients | |
| Calhoun-Liberty Hospital Association Inc | Current |
Accepting new patients | |
| Physician Services Group of Florida, LLC | Current |
Accepting new patients | |
| Calhoun-Liberty Hospital Association Inc | Current |
Accepting new patients | |
| Psgfl MSSP, LLC | Past |
Accepting new patients | |
| Calhoun Liberty Hospital Association, Inc. | Past | Accepting new patients |
Locations
20370 NE Burns Ave
Blountstown, FL 32424
Phone (850) 237-3000
16257 State Road 71 S
Blountstown, FL 32424
Phone (850) 674-5411
1360 Brickyard Rd
Chipley, FL 32428
Phone (850) 415-8300
1360 Brickyard Rd
Fl Co
Chipley, FL 32428
Phone (850) 638-1610
8325 University Pkwy
Ste A
Pensacola, FL 32514
Phone (850) 324-9633
Interoperability endpoints
- https://fhir-usa.unify.chbase.com/org/liberty-4ff80e3e
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | ARNP9363859 | FL | Yes |
Addresses
Primary practice location
1360 Brickyard Rd
Chipley, FL 32428-6303
Mailing address
2037 Old Bonifay Rd
Chipley, FL 32428-6119
Phone (850) 849-3715
Other providers in Chipley, FL
- James Guy
- Guyson Construction
- Nathanael L Hawkins
- Healing Hearts Ministries
- Health Clinic LLC
- Courtney Ann Hill
- Holiday CVS LLC
- Home Sweet Home
- Horizon Health Care Services Inc.
- Horizon Health Care Services, Inc
All providers in Chipley, FL · Family Nurse Practitioner in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 29, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.