Individual provider · Type 1 NPI

Melinda Sue Hickey, MSN, AGNP-C, CWON

Primary Care Nurse Practitioner · Peoria, IL

NPI number 1396453346 Active

Practice location

221 NE Glen Oak Ave
Peoria, IL 61636-0001

Mailing address

355 S Bridge St
Banner, IL 61520-9307

Specialties and licenses

TaxonomyCodeLicense
Gerontology Nurse Practitioner 363LG0600X209027429 (IL)
Primary Care Nurse Practitioner Primary 363LP2300XAG09220121 (IL)

Primary Care Nurse Practitioner: Definition to come...

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About NPI 1396453346

Melinda Sue Hickey, MSN, AGNP-C, CWON's National Provider Identifier is 1396453346, issued on Nov 8, 2022. The primary taxonomy on file is Primary Care Nurse Practitioner (363LP2300X), and the practice location is in Peoria, IL. The record was last updated on May 13, 2025.