MEDICARE: DR. KATHYRN JANELL RICKARD DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	OT019109	PA
2	207Q00000X	Family Medicine Physician	34.015957	OH

General Provider Information

NPI Number	:	1942868484
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHYRN JANELL RICKARD DO

Provider Business Mailing Address
First Line	:	8054 DARROW RD STE 3
Second Line	:
City	:	TWINSBURG
State	:	OH
Zip	:	44087-2387
Country	:	US
Telephone Number	:	330-425-1485
Fax Number	:	330-405-7960

Provider Business Practice Location Address
First Line	:	8054 DARROW RD STE 3
Second Line	:
City	:	TWINSBURG
State	:	OH
Zip	:	44087-2387
Country	:	US
Telephone Number	:	330-425-1485
Fax Number	:	330-405-7960

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/30/2019
Last Update Date	:	07/12/2022

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