Active NPI
Patty Hicks, PA
- Physician Assistant
- Killeen, TX
National Provider Identifier
1316900624
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA01873
- Practice address
- 2201 S W S Young Dr
Suite 111-B
Killeen, TX 76543-5317 - Phone
- (254) 680-3376
- Fax
- (254) 680-5252
- NPI assigned
- Apr 8, 2006
- Last updated
- Oct 11, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA01873 | TX | Primary |
Addresses
Primary practice location
2201 S W S Young Dr
Suite 111-B
Killeen, TX 76543-5317
Mailing address
1809 SW H K Dodgen Loop
Suite 100
Temple, TX 76502-1815
Phone (254) 778-5400
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PA01873 | Other | TX | TX LICENSE NUMBER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dermatology Group of SL PA | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Dermatology Physician
- Sugar Land, TX
- NPI 1790745198
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1144454400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1192060800000",
"number": "1316900624",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1809 SW H K DODGEN LOOP",
"address_2": "SUITE 100",
"city": "TEMPLE",
"state": "TX",
"postal_code": "765021815",
"telephone_number": "254-778-5400",
"fax_number": "254-778-5444"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2201 S W S YOUNG DR",
"address_2": "SUITE 111-B",
"city": "KILLEEN",
"state": "TX",
"postal_code": "765435317",
"telephone_number": "254-680-3376",
"fax_number": "254-680-5252"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HICKS",
"first_name": "PATTY",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-04-08",
"last_updated": "2007-10-11",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "TX",
"license": "PA01873",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TX LICENSE NUMBER",
"identifier": "PA01873",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Killeen, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.