Hicks, Matthew David

Hicks, Matthew David is an individual health care provider with primary practice located at 1200 W Walnut St , Rogers AR 72756-3546. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered, which is considered as his primary health care specialty. Hicks, Matthew David can be contacted via phone (479) 636-0200.

Contact Information

Primary practice address
1200 W Walnut St Rogers AR 72756-3546
Phone: (479) 636-0200
Fax: (479) 936-2912
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered 367500000X CO1400 Arkansas

Profile Details

NPI number 1316907959
LBN Legal business name Hicks, Matthew David
Credentials Certified Registered Nurse Anesthetist (CRNA)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 27th, 2006
Last updated Dec 6th, 2007 - about 19 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1316907959 NPPES
Missouri MEDICAID 919212001
Missouri MEDICAID 150123701

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