Provider Demographics
NPI:1023813870
Name:HICKS, CRYSTAL LEE ANN DENISE
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:LEE ANN DENISE
Last Name:HICKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 185
Mailing Address - Street 2:
Mailing Address - City:PALISADE
Mailing Address - State:NE
Mailing Address - Zip Code:69040-0185
Mailing Address - Country:US
Mailing Address - Phone:308-883-0646
Mailing Address - Fax:
Practice Address - Street 1:209 S OSBORN ST
Practice Address - Street 2:
Practice Address - City:PALISADE
Practice Address - State:NE
Practice Address - Zip Code:69040-6165
Practice Address - Country:US
Practice Address - Phone:308-883-0646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-17
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist