Provider Demographics
NPI:1366767550
Name:HICKSON, SHONDELL VANESSA (APN)
Entity type:Individual
Prefix:MRS
First Name:SHONDELL
Middle Name:VANESSA
Last Name:HICKSON
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2237 LOWES DR W STE A
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-6891
Mailing Address - Country:US
Mailing Address - Phone:931-272-2446
Mailing Address - Fax:510-275-0697
Practice Address - Street 1:2237 LOWES DR W STE A
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-6891
Practice Address - Country:US
Practice Address - Phone:931-272-2446
Practice Address - Fax:510-275-0697
Is Sole Proprietor?:No
Enumeration Date:2010-03-31
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN14841364SA2200X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health