Provider Demographics
NPI:1174013924
Name:HICKS, BEVERLY JANE
Entity type:Individual
Prefix:MRS
First Name:BEVERLY
Middle Name:JANE
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 88
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37756-0088
Mailing Address - Country:US
Mailing Address - Phone:423-663-2445
Mailing Address - Fax:423-663-9252
Practice Address - Street 1:344 COURT ST
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37756-1404
Practice Address - Country:US
Practice Address - Phone:423-663-2445
Practice Address - Fax:423-663-9252
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-17
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Single Specialty