NPIMap

Beverly W Hicks, RN

Individual provider Active NPI Behavior Analyst · Fort Valley, GA

NPI 1649534322 · NPPES record last updated Jun 27, 2012

Key facts

NPI
1649534322
Entity type
Individual (NPI type 1)
Primary specialty
Behavior Analyst 103K00000X
License
RN081233 (GA)
Practice address
378 Tabor Rd
Fort Valley, GA 31030-6024
Phone
(478) 971-4684
NPI assigned
Jun 27, 2012
Sex
Female
Sole proprietor
No

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No
Credentials
Registered Nurse

State licenses

LicenseStateTypeSpecialty
RN081233GAMDBehavioral Analyst

Practice roles

OrganizationSpecialtyStatusNew patients
Great Expectations Unlimited, LLC Past
since Jan 15, 2015		 Accepting new patients
The Regeneration Project Past Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Analyst 103K00000X RN081233 GA Yes

Addresses

Primary practice location

378 Tabor Rd
Fort Valley, GA 31030-6024

Mailing address

378 Tabor Rd
Fort Valley, GA 31030-6024
Phone (478) 971-4684

Other providers in Fort Valley, GA

All providers in Fort Valley, GA · Behavior Analyst in Georgia

Sources for this page

Verify at the official NPI Registry.