Provider Demographics
NPI:1538668884
Name:RICKER, AMY SUZANNE (NP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:SUZANNE
Last Name:RICKER
Suffix:
Gender:F
Credentials:NP
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9300 MEDICAL PLAZA DR STE B
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-9334
Mailing Address - Country:US
Mailing Address - Phone:843-764-1730
Mailing Address - Fax:843-764-1731
Practice Address - Street 1:9300 MEDICAL PLAZA DR STE B
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9334
Practice Address - Country:US
Practice Address - Phone:843-764-1730
Practice Address - Fax:843-764-1731
Is Sole Proprietor?:No
Enumeration Date:2018-02-01
Last Update Date:2022-02-10
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Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC21268208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery