Susan Elaine Hickman, PHD, PSYD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

P0000002807 Issued in TN

Practice address

3212 Dayton Blvd Ste B
Red Bank, TN 37415-5046

Phone

(423) 508-8200

NPI assigned

Oct 2, 2007

Last updated

Dec 31, 2019By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1191283200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1577750400000",
    "number": "1174710396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3212 DAYTON BLVD STE B",
            "city": "RED BANK",
            "state": "TN",
            "postal_code": "374155046",
            "telephone_number": "423-508-8200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3212 DAYTON BLVD STE B",
            "city": "RED BANK",
            "state": "TN",
            "postal_code": "374155046",
            "telephone_number": "423-508-8200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HICKMAN",
        "first_name": "SUSAN",
        "middle_name": "ELAINE",
        "name_prefix": "Dr.",
        "credential": "PHD, PSYD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-10-02",
        "last_updated": "2019-12-31",
        "certification_date": "2019-12-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "TN",
            "license": "P0000002807",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Psychologist in Red Bank, TN
• Providers in Red Bank, TN by specialty
• Clinical Psychologist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.