Provider Demographics
NPI:1336102714
Name:RIKE, DONNA ROBERSON (FNP)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:ROBERSON
Last Name:RIKE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:768 EVERETT ST
Mailing Address - Street 2:STE 1
Mailing Address - City:TIPTONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38079-1608
Mailing Address - Country:US
Mailing Address - Phone:731-253-3760
Mailing Address - Fax:731-253-3762
Practice Address - Street 1:768 EVERETT ST
Practice Address - Street 2:STE 1
Practice Address - City:TIPTONVILLE
Practice Address - State:TN
Practice Address - Zip Code:38079-1608
Practice Address - Country:US
Practice Address - Phone:731-253-3760
Practice Address - Fax:731-253-3762
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2014-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000083439363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3902647Medicare PIN
S84138Medicare UPIN