MEDICARE: DR. RONALD GENE RICKNER PHD

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	103TC0700X	Clinical Psychologist	PY0005144	FL

General Provider Information

NPI Number	:	1386624229
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RONALD GENE RICKNER PHD

Provider Business Mailing Address
First Line	:	1535 KILLEARN CNTR BLVD
Second Line	:	SUITE C-2
City	:	TALLAHASSEE
State	:	FL
Zip	:	32309
Country	:	US
Telephone Number	:	850-668-0482
Fax Number	:	850-894-9957

Provider Business Practice Location Address
First Line	:	1535 KILLEARN CNTR BLVD
Second Line	:	SUITE C-2
City	:	TALLAHASSEE
State	:	FL
Zip	:	32309
Country	:	US
Telephone Number	:	850-668-0482
Fax Number	:	850-894-9957

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

Provider Enumeration Date	:	01/18/2006
Last Update Date	:	05/16/2014

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