Kyle Douglas Hicks

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

95022187 Issued in CA

Practice address

20 E River Park PL W
Fresno, CA 93720-1551

Phone

(559) 256-4950

NPI assigned

Jan 18, 2024

Last updated

Jan 18, 2024By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

Enrollment records 1

Specialty

Certified Registered Nurse Anesthetist (Crna)

Education

Other, 2025

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Northeastern Anesthesia PLLCGroup PAC ID 4284813940, 83 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Havasu Regional Medical Center Hospital, Lake Havasu City, AZ, CCN 030069
• Valley View Medical Center Hospital, Fort Mohave, AZ, CCN 030117
• Kingman Regional Medical Center Hospital, Kingman, AZ, CCN 030055
• Western Arizona Regional Medical Center Hospital, Bullhead City, AZ, CCN 030101

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Northeastern Anesthesia PLLC

  • Anesthesiology Physician
  • Sierra Vista, AZ
  • NPI 1487956504
  Medicare reassignment Care Compare group

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Bullhead City Hospital Corporation

  dba Western Arizona Regional Medical Center

  • General Acute Care Hospital
  • Bullhead City, AZ
  • NPI 1255302766
  Care Compare affiliation
• Bullhead City Hospital Corporation

  dba Fox Creek Urgent Care

  • Urgent Care Clinic/Center
  • Bullhead City, AZ
  • NPI 1780996223

  Hospital

  Care Compare affiliation
• Havasu Regional Medical Center LLC

  dba Havasu Regional Medical Center

  • Rural Acute Care Hospital
  • Lake Havasu City, AZ
  • NPI 1780761866
  Care Compare affiliation
• Kingman Healthcare, Inc

  dba Kingman Regional Medical Center

  • General Acute Care Hospital
  • Kingman, AZ
  • NPI 1265423917
  Care Compare affiliation
• PHC-Fort Mohave Inc

  dba Valley View Medical Center

  • General Acute Care Hospital
  • Fort Mohave, AZ
  • NPI 1811086994
  Care Compare affiliation

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

{
    "created_epoch": "1705536000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705536000000",
    "number": "1700647542",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3222 EVERGLADE AVE # A",
            "city": "CLOVIS",
            "state": "CA",
            "postal_code": "936199586",
            "telephone_number": "559-999-0660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 E RIVER PARK PL W",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937201551",
            "telephone_number": "559-256-4950"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HICKS",
        "first_name": "KYLE",
        "middle_name": "DOUGLAS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-01-18",
        "last_updated": "2024-01-18",
        "certification_date": "2024-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95022187",
            "primary": true
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "CA",
            "license": "95069170",
            "primary": false
        },
        {
            "code": "163WC0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Critical Care Medicine",
            "state": "CA",
            "license": "95069170",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christina L Hicks, MSW
• David Lawrence Hicks, M.D.
• Esther Noel Hicks
• Garrett Douglas Hicks
• Gloria Hicks
• Linda May Hicks, RN
• Loretta Charlene Hicks, RN/MSN/PNP/FNP
• Neshondra Hicks
• Randy Scott Hicks, P.T.
• Taylor Mae Hicks

• Family Nurse Practitioner in Fresno, CA
• Providers in Fresno, CA by specialty
• Family Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.