Healthcare Provider Details

I. General information

NPI: 1306664099
Provider Name (Legal Business Name): ASHLEY RICKS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2024
Last Update Date: 10/01/2024
Certification Date: 10/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3060 VALLEY CREEK DR
BATON ROUGE LA
70808-3169
US

IV. Provider business mailing address

12187 ARCHERY DR
BATON ROUGE LA
70815-6506
US

V. Phone/Fax

Practice location:
  • Phone: 225-923-3733
  • Fax: 225-923-3735
Mailing address:
  • Phone: 225-892-7530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: