Angie D Hicks-Master, ANP
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · Manila, AR
NPI 1255405353 · NPPES record last updated May 28, 2022
Key facts
- NPI
- 1255405353
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- APN0000017515 (TN)
- Practice address
- 920 East Medical Drive
Manila, AR 72442 - Phone
- (810) 570-0358
- Fax
- (870) 570-0359
- NPI assigned
- Nov 20, 2006
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 9
-
Jim Pang Jr., M.D.
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2005
- Medicare assignment
- May accept Medicare assignment
- Telehealth
- Offers telehealth services
- Group practices
- Foundation a Wellness Practice, LLC
Delta Behavioral Health, LLC
Practice addresses (Care Compare)
533 W Washington Ave
Jonesboro, AR 72401-2782
Phone (870) 229-0302
920 E Medical Dr
Manila, AR 72442-8416
Phone (870) 570-0358
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in AR, TN
- 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 |
|---|---|---|---|---|
| I20070316000197 | AR | Practitioner - Nurse Practitioner | 5496858110 | Reassigns benefits to 4 organizations |
| I20130826000960 | TN | Practitioner - Nurse Practitioner | 5496858110 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A002923 | AR | MD | Psychiatric/Mental Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Delta Behavioral Health, LLC | Current |
Accepting new patients | |
| Northeast Arkansas Community Mental Health Center | Current |
Accepting new patients | |
| Northeast Arkansas Community Mental Health Center Inc | Current |
Accepting new patients | |
| Jim Pang MD PLLC | Current |
Accepting new patients | |
| Foundation: a Wellness Practice, LLC | Current |
Accepting new patients | |
| Northeast Arkansas Community Mental Health Center Inc | Current | Accepting new patients | |
| Advanced Psychiatric Services | Past | Accepting new patients | |
| Vanderbilt University | Past |
Accepting new patients |
Locations
209 S Lockard St
Blytheville, AR 72315
Phone (870) 763-2139
533 W Washington Ave
Jonesboro, AR 72401
Phone (870) 229-0302
2707 Browns Ln
Jonesboro, AR 72401
Phone (870) 972-4000
920 Medical Dr
Manila, AR 72442
Phone (870) 570-0358
8000 Centerview Pkwy
Ste 301
Cordova, TN 38018
Phone (901) 752-4900
65 Germantown Ct
Ste 402
Cordova, TN 38018
Phone (901) 752-4900
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | A002923 | AR | |
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | APN0000017515 | TN | Yes |
Addresses
Primary practice location
920 East Medical Drive
Manila, AR 72442
Mailing address
P.O. Box 717
Manila, AR 72442
Phone (870) 570-0358
Other practice location 1
310 E Lake St
Manila, AR 72442
Phone (870) 243-3960
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2007012778 | Other | MO | MO STATE LICENSE |
| A002923 | Other | AR | AR STATE LICENSE |
| 17515 | Other | TN | TN STATE LICENSE |
Other providers in Manila, AR
- Nakisha Nicole Fuentes
- Victoria L Gamble
- Angela Gipson
- Colton Stacy Golden
- Madison Joy Hawkins
- Allison Nicole Hitt
- Yvonne Holmes
- Home Oxygen Care, Inc.
- Khali Houart
- Mystique Leigh Imler
All providers in Manila, AR · Psychiatric/Mental Health Nurse Practitioner in Arkansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 28, 2022. 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.