Healthcare Provider Details

I. General information

NPI: 1700865847
Provider Name (Legal Business Name): CHARLES EDWARD RICKARD JR. MSN,APRN,BC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/16/2006
Last Update Date: 03/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

557 W PARK PL
HENDERSON TN
38340-2027
US

IV. Provider business mailing address

9 PHYSICIANS DR
JACKSON TN
38305-2071
US

V. Phone/Fax

Practice location:
  • Phone: 731-989-1007
  • Fax: 731-989-0704
Mailing address:
  • Phone: 731-989-1007
  • Fax: 731-989-0704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN0000006144
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: