Provider Demographics
NPI:1174037790
Name:RICKARD, KASSY (APRN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:KASSY
Middle Name:
Last Name:RICKARD
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9086 STATE ROUTE 132 WEST
Mailing Address - Street 2:
Mailing Address - City:CLAY
Mailing Address - State:KY
Mailing Address - Zip Code:42404
Mailing Address - Country:US
Mailing Address - Phone:270-664-2526
Mailing Address - Fax:270-664-6082
Practice Address - Street 1:9086 STATE ROUTE 132 WEST
Practice Address - Street 2:
Practice Address - City:CLAY
Practice Address - State:KY
Practice Address - Zip Code:42404
Practice Address - Country:US
Practice Address - Phone:270-664-2526
Practice Address - Fax:270-664-6082
Is Sole Proprietor?:No
Enumeration Date:2017-11-17
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3011835363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN23095OtherTN APN
KY3011835OtherAPN LICENSE