Healthcare Provider Details

I. General information

NPI: 1154138170
Provider Name (Legal Business Name): ANDREW M RICKS RN, BSN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2024
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15790 PAUL VEGA MD DR
HAMMOND LA
70403-1436
US

IV. Provider business mailing address

356 LIONS ST
JEFFERSON LA
70121-3504
US

V. Phone/Fax

Practice location:
  • Phone: 985-230-2198
  • Fax: 985-230-2159
Mailing address:
  • Phone: 504-615-6939
  • 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 StateLA
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number205658
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code163WN0800X
TaxonomyNeuroscience Registered Nurse
License Number205658
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: