Provider Demographics
NPI:1619668332
Name:FERNANDEZ, RIKKIE L (MS, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:RIKKIE
Middle Name:L
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:824 KING ALBERT ST # A
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-3965
Mailing Address - Country:US
Mailing Address - Phone:337-302-7067
Mailing Address - Fax:
Practice Address - Street 1:1700 LEHMAN RD
Practice Address - Street 2:
Practice Address - City:KYLE
Practice Address - State:TX
Practice Address - Zip Code:78640-5246
Practice Address - Country:US
Practice Address - Phone:512-268-8454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT66492255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer