Healthcare Provider Details

I. General information

NPI: 1730093378
Provider Name (Legal Business Name): RICKY DEAN VANDERHOOF RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 STAGHORN CT
LASCASSAS TN
37085-4229
US

IV. Provider business mailing address

905 STAGHORN CT
LASCASSAS TN
37085-4229
US

V. Phone/Fax

Practice location:
  • Phone: 615-867-6000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number119788
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: