Provider Demographics
NPI:1922003250
Name:RICKARD, KATHLEEN B (DNP, FNP-C)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:B
Last Name:RICKARD
Suffix:
Gender:F
Credentials:DNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11209 N TATUM BLVD STE 160
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-3092
Mailing Address - Country:US
Mailing Address - Phone:480-285-2180
Mailing Address - Fax:480-285-2182
Practice Address - Street 1:11209 N TATUM BLVD STE 160
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-3092
Practice Address - Country:US
Practice Address - Phone:480-285-2180
Practice Address - Fax:480-285-2182
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN046461363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ393934Medicaid
AZ76112Medicare ID - Type Unspecified
AZS51683Medicare UPIN