Provider Demographics
NPI:1659746550
Name:RICKERD, WENDY J (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:J
Last Name:RICKERD
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 MASSILLON RD
Mailing Address - Street 2:STE 102
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44312-5982
Mailing Address - Country:US
Mailing Address - Phone:855-925-4733
Mailing Address - Fax:
Practice Address - Street 1:3333 MASSILLON RD
Practice Address - Street 2:STE 102
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44312-5982
Practice Address - Country:US
Practice Address - Phone:330-926-3235
Practice Address - Fax:330-255-5084
Is Sole Proprietor?:No
Enumeration Date:2015-12-03
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.252149-1363LF0000X
OHAPRN.CNP.17435363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0155965Medicaid