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General NPI Number Information
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NPI Number | 1376702654
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Entity Type | Individual
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Provider Name | CHARLES CHRISTIAN RICKEY PA-C
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Gender | Male
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Dates
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Enumeration Date | 06/03/2008
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Last Update Date | 03/27/2015
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Provider Practice Location Address
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Address Line | 265 BROOKVIEW CENTRE WAY STE 400
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City | KNOXVILLE
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State | TN
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Zip | 37919-4052
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Country | US
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Telephone | 865-293-5335
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Fax |
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Provider Business Mailing Address
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Address Line | 379 ASHLEY ST
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City | FLEMINGSBURG
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State | KY
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Zip | 41041-8777
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Country | US
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Telephone | 606-615-3265
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA 837
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | KY PA 837
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License Number State | KY
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