Healthcare Provider Details

I. General information

NPI: 1851978746
Provider Name (Legal Business Name): KAREN RICKARD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2021
Last Update Date: 03/26/2021
Certification Date: 03/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

753 SPANKER BRANCH RD
FAIRDALE WV
25839
US

IV. Provider business mailing address

PO BOX 258
FAIRDALE WV
25839-0258
US

V. Phone/Fax

Practice location:
  • Phone: 304-573-6411
  • Fax:
Mailing address:
  • Phone: 304-934-6411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: