Provider Demographics
NPI:1124021381
Name:HENDRIX, RICKY DALE (MD)
Entity Type:Individual
Prefix:
First Name:RICKY
Middle Name:DALE
Last Name:HENDRIX
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1334
Mailing Address - Street 2:
Mailing Address - City:WINNFIELD
Mailing Address - State:LA
Mailing Address - Zip Code:71483-1334
Mailing Address - Country:US
Mailing Address - Phone:318-628-5565
Mailing Address - Fax:318-628-5950
Practice Address - Street 1:201 4TH ST STE 5A
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-8421
Practice Address - Country:US
Practice Address - Phone:318-483-1961
Practice Address - Fax:318-483-1964
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-23
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.016338207RN0300X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1348732Medicaid
LA1348732Medicaid
LAB61731Medicare UPIN