Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Dr. Annelies Hickerson, MD

Individual provider Surgery Physician · NPI 1629469473

Dr. Annelies Hickerson, MD is a General Surgery in Fort Campbell, Kentucky. Qualified in 2015, 11 years ago. Practices with St Lukes Clinic-Treasure Valley LLC, a 1,150-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Idaho and Virginia.

Years since qualifying
11
Licensed in
ID, VA
In the registry since
2015
Specialties on file
2
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

650 Joel Dr
Fort Campbell, KY 42223-5318
Phone: (270) 412-6594
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 520 S Eagle Rd Ste 1241, Meridian, ID 83642-6355 — (208) 381-6930

Specialties & licences

Surgery Physician (primary) Taxonomy 208600000X · Licence 0101262158 (VA)
Surgery Physician Taxonomy 208600000X · Licence 5771767 (ID)

Record details

NPI number1629469473
Entity typeIndividual (Type 1)
GenderFemale
Credentials MD
Sole proprietorNo
NPI enumeratedFebruary 16, 2015
Last updated in NPPESAugust 21, 2025
Certification dateAugust 21, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyGENERAL SURGERY
Medical schoolOTHER
Graduated 2015 (11 years in practice)
Group practice St Lukes Clinic-Treasure Valley Llc — 1150 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations4 on file with Medicare

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