Individual provider Active NPI

Kerrie Jean Hickman, PA-C

  • Physician Assistant
  • London, KY
National Provider Identifier
1659518165
Registry record updated Jun 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA1337 Issued in KY
Practice address
1001 Saint Joseph LN
London, KY 40741-8345
Phone
(606) 330-6000
NPI assigned
Jan 21, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 9, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 1686 TN
Physician Assistant 363A00000X PA1337 KY Primary

Addresses

Primary practice location

1001 Saint Joseph LN
London, KY 40741-8345

Mailing address

1221 S Broadway
Lexington, KY 40504-2701
Phone (859) 258-6200

Other practice location 1

1221 S Broadway
Lexington, KY 40504-2701
Phone (859) 258-4000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130313000512 KY Practitioner - Physician Assistant 2769627058 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
1686TNMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
Cogent Healthcare of Kentucky, PSC Physician Assistant CurrentSince May 26, 2020 Accepting new patients
New Lexington Clinic PSC CurrentSince May 10, 2023 Accepting new patients
New Lexington Clinic, PSC CurrentSince May 10, 2023 Accepting new patients

Locations

1 Saint Joseph Dr
Lexington, KY 40504
Phone (502) 350-5000

1221 S Broadway
Lexington, KY 40504
Phone (859) 258-4181

150 N Eagle Creek Dr
Lexington, KY 40509
Phone (859) 267-9773

740 E Laurel Rd
London, KY 40741
Phone (606) 877-3931

1001 Saint Joseph Ln
London, KY 40741
Phone (606) 330-6000

310 E 9th St
London, KY 40741
Phone (606) 878-2227

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1232496000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686268800000",
    "number": "1659518165",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1221 S BROADWAY",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405042701",
            "telephone_number": "859-258-6200",
            "fax_number": "859-258-6203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 SAINT JOSEPH LN",
            "city": "LONDON",
            "state": "KY",
            "postal_code": "407418345",
            "telephone_number": "606-330-6000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1221 S Broadway",
            "address_purpose": "LOCATION",
            "city": "Lexington",
            "state": "KY",
            "postal_code": "405042701",
            "country_code": "US",
            "telephone_number": "859-258-4000",
            "fax_number": "859-258-6203",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HICKMAN",
        "first_name": "KERRIE",
        "middle_name": "JEAN",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-01-21",
        "last_updated": "2023-06-09",
        "certification_date": "2023-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TN",
            "license": "1686",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "KY",
            "license": "PA1337",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in London, KY

Sources for this page

Verify at the official NPI Registry.