Provider Demographics
NPI:1205572336
Name:RICAHRDS, TRACY (LPN)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:RICAHRDS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 MARTIN DR
Mailing Address - Street 2:
Mailing Address - City:FLEMING
Mailing Address - State:OH
Mailing Address - Zip Code:45729-5083
Mailing Address - Country:US
Mailing Address - Phone:740-336-8533
Mailing Address - Fax:
Practice Address - Street 1:27843 STATE ROUTE 7
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-9060
Practice Address - Country:US
Practice Address - Phone:800-358-8262
Practice Address - Fax:740-568-0413
Is Sole Proprietor?:No
Enumeration Date:2022-05-11
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH115482164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse