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NPI Code Detail

MEDICARE: ADRIAN RICKETTS DAVIES PA

MEDICARE: ADRIAN RICKETTS DAVIES PA
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
1363A00000XPhysician Assistant1151615TN
2363A00000XPhysician Assistant3603TN
3363A00000XPhysician AssistantPA2026-0017NM
4363A00000XPhysician AssistantTC954KY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1TC954OTHERKYSTATE LICENSE
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
33603OTHERTNSTATE LICENSE
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1366934382
Entity Type Code : Individual
Provider Name (Legal Business Name) : ADRIAN RICKETTS DAVIES PA
Provider Business Mailing Address
First Line : 6419 BRISTOL HWY
Second Line :
City : PINEY FLATS
State : TN
Zip : 37686-5208
Country : US
Telephone Number : 615-202-3359
Fax Number :
Provider Business Practice Location Address
First Line : 1901 JUAN TABO BLVD NE
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87112-3303
Country : US
Telephone Number : 505-281-5180
Fax Number : 505-702-8171
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/05/2018
Last Update Date : 03/19/2026

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Directions to “ ADRIAN RICKETTS DAVIES PA” Practice Location

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