Darrell W Hickerson Jr., MPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

112723 Issued in MO

Practice address

1300 Verterans Blvd.
Festus, MO 63028

Phone

(636) 931-2100

NPI assigned

Jun 21, 2007

Sex

Male

Sole proprietor

No

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

State licenses

Interoperability endpoints

• Direct secure messaging: darrell.hickerson.p2@direct.athleticoltd.nextgenshare.com

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

{
    "created_epoch": "1182384000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571011200000",
    "number": "1245436898",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "625 ENTERPRISE DR.",
            "city": "OAKBROOK",
            "state": "IL",
            "postal_code": "60523",
            "telephone_number": "630-575-6250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 VERTERANS BLVD.",
            "city": "FESTUS",
            "state": "MO",
            "postal_code": "63028",
            "telephone_number": "636-931-2100"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12639 Old Tesson Rd",
            "address_2": "Suite 120",
            "address_purpose": "LOCATION",
            "city": "Saint Louis",
            "state": "MO",
            "postal_code": "631282786",
            "country_code": "US",
            "telephone_number": "314-842-3968",
            "fax_number": "314-842-5236",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1300 Verterans Blvd.",
            "address_purpose": "LOCATION",
            "city": "Festus",
            "state": "MO",
            "postal_code": "63028",
            "country_code": "US",
            "telephone_number": "636-931-2100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HICKERSON",
        "first_name": "DARRELL",
        "middle_name": "W",
        "name_suffix": "Jr.",
        "credential": "MPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-21",
        "last_updated": "2019-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MO",
            "license": "112723",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Haley Leann Heaton
• Brian James Heberer, D.O.
• Annie Heggemann, RD
• Jesse Dwayne Helton, D.O.
• Katy Herman
• Shawn Hicks
• Robert John Hieger, MD
• Kay-Anne Hiller, RPH
• Benton Hoang, DMD
• Angela Marie Hoffman

• Physical Therapist in Festus, MO
• Providers in Festus, MO by specialty
• Physical Therapist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 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.