NPIMap

Individual provider Active NPI

Brandi Linette Hicks, R.N., C.R.N.P.

  • Physician Assistant
  • Bridgeport, AL
National Provider Identifier
1740331024
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
1-090559 Issued in AL
Practice address
47053 Al Highway 277
Suite C
Bridgeport, AL 35740-7205
Phone
(256) 437-0555
Fax
(256) 437-0404
NPI assigned
Jan 15, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 1-090559 AL Primary

Addresses

Primary practice location

47053 Al Highway 277
Suite C
Bridgeport, AL 35740-7205

Mailing address

47053 Al Highway 277
Suite C
Bridgeport, AL 35740-7205
Phone (256) 437-0555

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)
Enrolled
Credentials
Nurse Practitioner, Registered Nurse

State licenses

LicenseStateTypeSpecialty
1-090559ALMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
North Jackson Primary Care Past Accepting new patients
Tennessee Valley Family Practice Associates PC Past Accepting new patients

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.

NPI Registry JSON

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

{
    "created_epoch": "1168819200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1740331024",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "47053 AL HIGHWAY 277",
            "address_2": "SUITE C",
            "city": "BRIDGEPORT",
            "state": "AL",
            "postal_code": "357407205",
            "telephone_number": "256-437-0555",
            "fax_number": "256-437-0404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "47053 AL HIGHWAY 277",
            "address_2": "SUITE C",
            "city": "BRIDGEPORT",
            "state": "AL",
            "postal_code": "357407205",
            "telephone_number": "256-437-0555",
            "fax_number": "256-437-0404"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HICKS",
        "first_name": "BRANDI",
        "middle_name": "LINETTE",
        "name_prefix": "Mrs.",
        "credential": "R.N., C.R.N.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-15",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AL",
            "license": "1-090559",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bridgeport, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.