Healthcare Provider Details

I. General information

NPI: 1558030288
Provider Name (Legal Business Name): SAMANTHA KAYE RICKARD FNP-BC, MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2021
Last Update Date: 02/23/2023
Certification Date: 02/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

426 E DR HICKS BLVD
FLORENCE AL
35630-5763
US

IV. Provider business mailing address

426 E DR HICKS BLVD
FLORENCE AL
35630-5763
US

V. Phone/Fax

Practice location:
  • Phone: 256-980-6214
  • Fax:
Mailing address:
  • Phone: 256-980-6214
  • Fax: 256-768-9187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1-145580
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number1-145580
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-145580
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: