MEDICARE: MR. CHARLES EDWARD RICKARD JR. MSN,APRN,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	APN0000006144	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0174180	OTHER	TN	BCBS

General Provider Information

NPI Number	:	1700865847
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHARLES EDWARD RICKARD JR. MSN,APRN,BC

Provider Business Mailing Address
First Line	:	9 PHYSICIANS DR
Second Line	:
City	:	JACKSON
State	:	TN
Zip	:	38305-2071
Country	:	US
Telephone Number	:	731-989-1007
Fax Number	:	731-989-0704

Provider Business Practice Location Address
First Line	:	557 W PARK PL
Second Line	:
City	:	HENDERSON
State	:	TN
Zip	:	38340-2027
Country	:	US
Telephone Number	:	731-989-1007
Fax Number	:	731-989-0704

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

Provider Enumeration Date	:	01/16/2006
Last Update Date	:	03/15/2018

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