Provider Demographics
NPI:1700865847
Name:RICKARD, CHARLES EDWARD JR (MSN,APRN,BC)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:EDWARD
Last Name:RICKARD
Suffix:JR
Gender:M
Credentials:MSN,APRN,BC
Other - Prefix:
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Mailing Address - Street 1:9 PHYSICIANS DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-2071
Mailing Address - Country:US
Mailing Address - Phone:731-989-1007
Mailing Address - Fax:731-989-0704
Practice Address - Street 1:557 W PARK PL
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:TN
Practice Address - Zip Code:38340-2027
Practice Address - Country:US
Practice Address - Phone:731-989-1007
Practice Address - Fax:731-989-0704
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-16
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNAPN0000006144363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3714672Medicaid
TN0174180OtherBCBS
TN3714672Medicaid
TN0174180OtherBCBS