Provider Demographics
NPI:1588837421
Name:MAYS, RICKEY CHARLES JR (ANP)
Entity Type:Individual
Prefix:MR
First Name:RICKEY
Middle Name:CHARLES
Last Name:MAYS
Suffix:JR
Gender:M
Credentials:ANP
Other - Prefix:MR
Other - First Name:RICKEY
Other - Middle Name:CHARLES
Other - Last Name:MAYS
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:ACNP
Mailing Address - Street 1:6720 BERTNER AVE
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2604
Mailing Address - Country:US
Mailing Address - Phone:823-355-2666
Mailing Address - Fax:
Practice Address - Street 1:6720 BERTNER AVE
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2604
Practice Address - Country:US
Practice Address - Phone:823-355-2666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-11
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95022164363LA2100X
TX732087363LA2100X, 363LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX197394301Medicaid
TX197394302Medicaid
TX8Y8543OtherBLUE CROSS BLUE SHIELD
TXP00643790OtherRAILROAD MEDICARE
TX324603YMVQMedicare PIN
TX197394302Medicaid
TXP00643790OtherRAILROAD MEDICARE