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General NPI Number Information
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NPI Number | 1851015127
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Entity Type | Organization
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Legal Business Name | INTEGRITY DIRECT PRIMARY CARE, LLC
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Dates
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Enumeration Date | 09/30/2022
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Last Update Date | 08/22/2023
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Provider Practice Location Address
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Address Line | 3637 CANAL ST
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City | NEW ORLEANS
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State | LA
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Zip | 70119-6110
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Country | US
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Telephone | 504-613-0315
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Fax | 504-613-0316
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Provider Business Mailing Address
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Address Line | 764 WALNUT KNOLL LN
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City | CORDOVA
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State | TN
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Zip | 38018-3113
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Country | US
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Telephone | 901-756-5565
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Fax | 901-756-5564
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Authorized Official
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Title or Position | OWNER/NP
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Name | JACOB ROBERT RICKOLL
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Credential | NP
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Telephone | 504-473-6943
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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