MEDICARE: ROBERT WESLEY RICKARD APRN, FNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	220055	AK
2	363LF0000X	Family Nurse Practitioner	AP111762	TX
3	363LF0000X	Family Nurse Practitioner	NUR-APRN-LIC-127234	MT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	647458	OTHER	TX	TEXAS BOARD OF NURSE EXAM
2	127234	OTHER	MT	MONTANA APRN LICENSE
3	111762	OTHER	TX	TX APN
4	220055	OTHER	AK	ALASKA APRN LICENSE

General Provider Information

NPI Number	:	1336162031
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT WESLEY RICKARD APRN, FNP-BC

Provider Business Mailing Address
First Line	:	2216 PADRE BLVD, SUITE B, PMB 511
Second Line	:
City	:	SOUTH PADRE ISLAND
State	:	TX
Zip	:	78597
Country	:	US
Telephone Number	:	956-564-0463
Fax Number	:

Provider Business Practice Location Address
First Line	:	2216 PADRE BLVD, SUITE B, PMB 511
Second Line	:
City	:	SOUTH PADRE ISLAND
State	:	TX
Zip	:	78597
Country	:	US
Telephone Number	:	956-564-0463
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	04/24/2025

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