Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 159196 | CA |
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 47153 | TX |
N | 207YP0228X | Pediatric Otolaryngology | 159196 | CA |
N | 207YS0123X | Facial Plastic Surgeon | 159196 | CA |
NPI | 1720320823 |
---|---|
Provider Name | Katherine Elizabeth Hicks |
First Address | Galveston, TX 77555-5302 |
Second Address | Sacramento, CA 95817-2207 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2013 |
Last Update Date | 27/09/2020 |