Provider Demographics
NPI:1578301958
Name:HICKS, TRACI LYNELL (CNM)
Entity type:Individual
Prefix:
First Name:TRACI
Middle Name:LYNELL
Last Name:HICKS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2813 BRETT RD NW
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35810-3306
Mailing Address - Country:US
Mailing Address - Phone:256-527-3552
Mailing Address - Fax:
Practice Address - Street 1:612 MADISON ST SE
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-4401
Practice Address - Country:US
Practice Address - Phone:256-527-3552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-18
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-100221176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife