Provider Demographics
NPI:1114202843
Name:BRAMLETT, RICKEY RAY
Entity Type:Individual
Prefix:
First Name:RICKEY
Middle Name:RAY
Last Name:BRAMLETT
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 1:1355 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72501-3159
Mailing Address - Country:US
Mailing Address - Phone:870-793-2311
Mailing Address - Fax:
Practice Address - Street 1:1355 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-3159
Practice Address - Country:US
Practice Address - Phone:870-793-2311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-13
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator