Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LG0600X | Nurse Practitioner - Gerontology | 026360 | OH |
Y | 363LG0600X | Nurse Practitioner - Gerontology | 3010153 | KY |
N | 363LG0600X | Nurse Practitioner - Gerontology | APRN93802 | WV |
NPI | 1013365279 |
---|---|
Provider Name | Tracy Ricewick |
First Address | Ashland, KY 41105-2379 |
Second Address | Ashland, KY 41101-2876 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/05/2016 |
Last Update Date | 05/01/2022 |