Basic Information
| Provider Information | |||||||||
| NPI: | 1851345144 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILLIAMS HICKMAN | ||||||||
| FirstName: | SALLY | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RN, CS-FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1100 KENTUCKY AENUE | ||||||||
| Address2: | |||||||||
| City: | WEST PLAINS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 65775 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4172569111 | ||||||||
| FaxNumber: | 4172559732 | ||||||||
| Practice Location | |||||||||
| Address1: | 1100 N KENTUCKY AVE | ||||||||
| Address2: | |||||||||
| City: | WEST PLAINS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 657752029 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4172569111 | ||||||||
| FaxNumber: | 4172559732 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/20/2006 | ||||||||
| LastUpdateDate: | 02/26/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 2004029904 | MO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 599022307 | 05 | MO | MEDICAID | 427376405 | 05 | MO | MEDICAID | 599022308 | 05 | MO | MEDICAID |