Provider Demographics
NPI:1861446858
Name:CHARLES E RICKARD JR FNP PC
Entity Type:Organization
Organization Name:CHARLES E RICKARD JR FNP PC
Other - Org Name:THE RICKARD CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:E
Authorized Official - Last Name:RICKARD
Authorized Official - Suffix:JR
Authorized Official - Credentials:FNP,MSN,APN,BC
Authorized Official - Phone:731-989-1007
Mailing Address - Street 1:557 W PARK PL
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:TN
Mailing Address - Zip Code:38340-2027
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN44-3960261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health