Healthcare Provider Details

I. General information

NPI: 1104839455
Provider Name (Legal Business Name): RICKIE L CALHOUN APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 ASH DR
DENISON TX
75020-6405
US

IV. Provider business mailing address

15 ASH DR
DENISON TX
75020-6405
US

V. Phone/Fax

Practice location:
  • Phone: 903-647-5391
  • Fax:
Mailing address:
  • Phone: 903-647-5391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number643565
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: