Provider Demographics
NPI:1336162031
Name:RICKARD, ROBERT WESLEY (APRN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:WESLEY
Last Name:RICKARD
Suffix:
Gender:M
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 2ND ST
Mailing Address - Street 2:
Mailing Address - City:PORT ISABEL
Mailing Address - State:TX
Mailing Address - Zip Code:78578-4100
Mailing Address - Country:US
Mailing Address - Phone:956-943-1774
Mailing Address - Fax:956-943-7938
Practice Address - Street 1:202 2ND ST
Practice Address - Street 2:
Practice Address - City:PORT ISABEL
Practice Address - State:TX
Practice Address - Zip Code:78578
Practice Address - Country:US
Practice Address - Phone:956-943-1774
Practice Address - Fax:956-943-7938
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP111762363LF0000X
MTNUR-APRN-LIC-127234363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX647458OtherTEXAS BOARD OF NURSE EXAM
TX111762OtherTX APN
TX111762OtherTX APN
TX647458OtherTEXAS BOARD OF NURSE EXAM
TX191706405Medicaid
TX191706404Medicaid
TXTXB134456Medicare PIN
TXQ64789Medicare UPIN