Provider Demographics
NPI:1841566429
Name:SMITH, RICKY EDWARD (CRNA)
Entity Type:Individual
Prefix:
First Name:RICKY
Middle Name:EDWARD
Last Name:SMITH
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5538
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93755-5538
Mailing Address - Country:US
Mailing Address - Phone:559-436-1000
Mailing Address - Fax:559-354-4235
Practice Address - Street 1:1 HOSPITAL DR SW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-6455
Practice Address - Country:US
Practice Address - Phone:256-429-5071
Practice Address - Fax:256-429-4674
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-28
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-064233367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALPENDINGMedicaid
PENDINGOtherBLUE CROSS BLUE SHIELD ALABAMA
PENDINGOtherBLUE CROSS BLUE SHIELD ALABAMA