| Angie D Hicks-master, ANP | |
|
920 East Medical Drive, Manila, AR 72442 | |
| (810) 570-0358 | |
| (870) 570-0359 |
| Full Name | Angie D Hicks-master |
|---|---|
| Gender | Female |
| Speciality | Nurse Practitioner |
| Experience | 20 Years |
| Location | 920 East Medical Drive, Manila, Arkansas |
| Accepts Medicare Assignments | May be. She may accept the Medicare-approved amount; you may be billed for more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255405353 | NPI | - | NPPES |
| 2007012778 | Other | MO | MO STATE LICENSE |
| A002923 | Other | AR | AR STATE LICENSE |
| 17515 | Other | TN | TN STATE LICENSE |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Foundation A Wellness Practice, Llc | 2668718172 | 4 |
| Delta Behavioral Health, Llc | 6406280007 | 5 |
| Entity Name | Jim Pang |
|---|---|
| Entity Type | Practitioner - Psychiatry |
| Entity Identifiers | NPI Number: 1780690230 PECOS PAC ID: 2769459338 Enrollment ID: I20070113000145 |
| Entity Name | Northeast Arkansas Community Mental Health Center Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1336118207 PECOS PAC ID: 0244130839 Enrollment ID: O20040110000206 |
| Entity Name | Foundation: A Wellness Practice, Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1750878203 PECOS PAC ID: 2668718172 Enrollment ID: O20190103002743 |
| Entity Name | Delta Behavioral Health, Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1720637085 PECOS PAC ID: 6406280007 Enrollment ID: O20200107000093 |
| Entity Name | A Time For Peace Pllc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1912392549 PECOS PAC ID: 1850627415 Enrollment ID: O20200901000136 |
| Mailing Address | Practice Location Address |
|---|---|
| Angie D Hicks-master, ANP P.o. Box 717, Manila, AR 72442 Ph: (870) 570-0358 | Angie D Hicks-master, ANP 920 East Medical Drive, Manila, AR 72442 Ph: (810) 570-0358 |
Karley Brooke Moore, Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 3644 W State Highway 18, Manila, AR 72442 Phone: 708-561-3300 Fax: 870-561-3307 | |
Kristy Lynn Wilson, APN Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 3364 W Hwy 18, Manila, AR 72442 Phone: 870-561-3300 Fax: 870-561-3307 | |
Lacey Poe, APRN Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 3644 W St Hwy 18, Suite B, Manila, AR 72442 Phone: 870-561-3300 Fax: 870-561-3307 | |
Morgan Bliss Noble, APRN Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 3644 Hwy 18 Bypass Ste. B, Manila, AR 72442 Phone: 870-561-3300 Fax: 870-561-3307 | |
Allison Nicole Hitt, ARPN Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 3644 W Hwy 18, Manila, AR 72442 Phone: 870-974-1110 | |
Danna Scott Deaton, APRN Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 3644 W St Hwy 18, Suite B, Manila, AR 72442 Phone: 870-561-3300 Fax: 870-561-3307 |