Active NPI
Prentice Charles Hickman, D.O.
- General Practice Physician
- Amarillo, TX
National Provider Identifier
1821139924
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Physician
- License
- D6775
- Practice address
- 4139 W. 34TH Ave.
Amarillo, TX 79109 - Phone
- (806) 355-8221
- NPI assigned
- Feb 9, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | D6775 | TX | Primary |
Addresses
Primary practice location
4139 W. 34TH Ave.
Amarillo, TX 79109
Mailing address
P.O. Box 8275
Amarillo, TX 79114
Phone (806) 355-8221
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)
- Not enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D6775 | TX | MD | General Practice Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170979200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1821139924",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "P.O. BOX 8275",
"city": "AMARILLO",
"state": "TX",
"postal_code": "79114",
"telephone_number": "806-355-8221"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4139 W. 34TH AVE.",
"city": "AMARILLO",
"state": "TX",
"postal_code": "79109",
"telephone_number": "806-355-8221"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HICKMAN",
"first_name": "PRENTICE",
"middle_name": "CHARLES",
"name_prefix": "Dr.",
"credential": "D.O.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-02-09",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "TX",
"license": "D6775",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Amarillo, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.