Provider Demographics
NPI:1255948022
Name:HACKNEY, RICKY
Entity type:Individual
Prefix:
First Name:RICKY
Middle Name:
Last Name:HACKNEY
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 1:4703 KANE PL NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-3943
Mailing Address - Country:US
Mailing Address - Phone:202-498-6036
Mailing Address - Fax:
Practice Address - Street 1:1130 47TH PL NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-3904
Practice Address - Country:US
Practice Address - Phone:202-709-2272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-25
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant