Provider Demographics
NPI:1083338925
Name:LINCOLN, DERRICK RICKY
Entity Type:Individual
Prefix:MR
First Name:DERRICK
Middle Name:RICKY
Last Name:LINCOLN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26463 SOLON RD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44146-4761
Mailing Address - Country:US
Mailing Address - Phone:216-269-9798
Mailing Address - Fax:
Practice Address - Street 1:26463 SOLON RD APT 203
Practice Address - Street 2:
Practice Address - City:BEDFORD HTS
Practice Address - State:OH
Practice Address - Zip Code:44146-4767
Practice Address - Country:US
Practice Address - Phone:216-269-9798
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant