Provider Demographics
NPI:1043303019
Name:HICKS, LATURE ELEASE (NP-C)
Entity type:Individual
Prefix:MRS
First Name:LATURE
Middle Name:ELEASE
Last Name:HICKS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 N WOOLSEY AVE
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-1847
Mailing Address - Country:US
Mailing Address - Phone:479-444-7548
Mailing Address - Fax:
Practice Address - Street 1:1100 N WOOLSEY AVE
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-1847
Practice Address - Country:US
Practice Address - Phone:479-444-7548
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA02945363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily