Provider Demographics
NPI:1205595816
Name:ROYAL, RICKY DONNELL
Entity type:Individual
Prefix:
First Name:RICKY
Middle Name:DONNELL
Last Name:ROYAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1338 R ST NW APT 413
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-4376
Mailing Address - Country:US
Mailing Address - Phone:202-910-1178
Mailing Address - Fax:
Practice Address - Street 1:2628 JASPER ST SE APT 2
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-2007
Practice Address - Country:US
Practice Address - Phone:202-910-1178
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-10
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant