Tamara Lynn Hickman, CPNP
Individual provider Active NPI Pediatric Nurse Practitioner · Charlevoix, MI
NPI 1699989665 · NPPES record last updated Jun 28, 2016
Key facts
- NPI
- 1699989665
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatric Nurse Practitioner 363LP0200X
- License
- 4704113645 (MI)
- Practice address
- Northwest Michigan Community Health Agency
220 W. Garfield Street
Charlevoix, MI 49720 - Phone
- (231) 547-6523
- Fax
- (231) 547-6238
- NPI assigned
- May 9, 2007
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Certified Pediatric Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4704113645 | MI | MD | Pediatric Nurse Practitioner |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Nurse Practitioner | 363LP0200X | 4704113645 | MI | Yes |
Addresses
Primary practice location
Northwest Michigan Community Health Agency
220 W. Garfield Street
Charlevoix, MI 49720
Mailing address
8275 W State St
Central Lake, MI 49622-9701
Phone (231) 544-6960
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| TH113645 | Other | MI | BCBSM LICENSE NUMBER |
| 4868054 | Medicaid | MI | |
| 50-0-A5-1010-0 | Other | MI | BCBSM |
Other providers in Charlevoix, MI
- Ryan Vincent Halbower
- Carl D Harlan Jr.
- Hawk Emergency Group, P.C.
- Ann Hazelwood
- Amanda Herscher
- Stephanie A Hinkley
- Ryan Keith Hooper
- Ruth E Hoppe
- Karlene Marie Howard
- Nichole Ivanov
All providers in Charlevoix, MI · Pediatric Nurse Practitioner in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 28, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.