Provider Demographics
NPI:1942868484
Name:RICKARD, KATHYRN JANELL (DO)
Entity Type:Individual
Prefix:DR
First Name:KATHYRN
Middle Name:JANELL
Last Name:RICKARD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:8054 DARROW RD STE 3
Mailing Address - Street 2:
Mailing Address - City:TWINSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:44087-2387
Mailing Address - Country:US
Mailing Address - Phone:330-425-1485
Mailing Address - Fax:330-405-7960
Practice Address - Street 1:8054 DARROW RD STE 3
Practice Address - Street 2:
Practice Address - City:TWINSBURG
Practice Address - State:OH
Practice Address - Zip Code:44087-2387
Practice Address - Country:US
Practice Address - Phone:330-425-1485
Practice Address - Fax:330-405-7960
Is Sole Proprietor?:No
Enumeration Date:2019-05-30
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT019109207Q00000X
OH34.015957207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine