Provider Demographics
NPI:1366179715
Name:HICKS, REBECCA JOY (CPM, LM)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:JOY
Last Name:HICKS
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4413 MIMOSA DR
Mailing Address - Street 2:
Mailing Address - City:MELISSA
Mailing Address - State:TX
Mailing Address - Zip Code:75454-0258
Mailing Address - Country:US
Mailing Address - Phone:805-297-7607
Mailing Address - Fax:
Practice Address - Street 1:4413 MIMOSA DR
Practice Address - Street 2:
Practice Address - City:MELISSA
Practice Address - State:TX
Practice Address - Zip Code:75454-0258
Practice Address - Country:US
Practice Address - Phone:805-297-7607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-05
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX99493176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife