MEDICARE: RICHARD VICKERS

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	172V00000X	Community Health Worker	246	TX
2	175T00000X	Peer Specialist

General Provider Information

NPI Number	:	1659579639
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD VICKERS

Provider Business Mailing Address
First Line	:	7449 CANDLERIDGE CIR APT 909
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76133-6509
Country	:	US
Telephone Number	:	817-903-2515
Fax Number	:

Provider Business Practice Location Address
First Line	:	7449 CANDLERIDGE CIR APT 909
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76133-6509
Country	:	US
Telephone Number	:	817-903-2515
Fax Number	:

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

Provider Enumeration Date	:	07/11/2007
Last Update Date	:	05/20/2025

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Directions to “ RICHARD VICKERS ” Practice Location

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