Active NPI
Kimberly Hicks
- Licensed Vocational Nurse
- Longview, TX
National Provider Identifier
1366061053
On this page
OIG exclusion record
The HHS Office of Inspector General’s List of Excluded Individuals/Entities (LEIE) contains a record with this NPI:
- Section 1128b(4) exclusion effective Mar 20, 2024.
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Vocational Nurse
- License
- 302735
- Practice address
- 2015 Majestic Pace St # a
Longview, TX 75604-2526 - Phone
- (903) 374-5282
- NPI assigned
- Apr 13, 2020
- 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 |
|---|---|---|---|---|
| Licensed Vocational Nurse | 164X00000X | 302735 | TX | Primary |
Addresses
Primary practice location
2015 Majestic Pace St # a
Longview, TX 75604-2526
Mailing address
2015 Majestic Pace St # a
Longview, TX 75604-2526
Phone (903) 374-5282
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)
- Not enrolled
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 302735 | TX | MD | Licensed Vocational Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1586736000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1586736000000",
"number": "1366061053",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2015 MAJESTIC PACE ST # A",
"city": "LONGVIEW",
"state": "TX",
"postal_code": "756042526",
"telephone_number": "903-374-5282"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2015 MAJESTIC PACE ST # A",
"city": "LONGVIEW",
"state": "TX",
"postal_code": "756042526",
"telephone_number": "903-374-5282"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HICKS",
"first_name": "KIMBERLY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-04-13",
"last_updated": "2020-04-13",
"certification_date": "2020-04-13",
"status": "A"
},
"taxonomies": [
{
"code": "164X00000X",
"taxonomy_group": "",
"desc": "Licensed Vocational Nurse",
"state": "TX",
"license": "302735",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Longview, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.