Basic Information
| Provider Information | |||||||||
| NPI: | 1851374318 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RICKLEY | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | EARL | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | JR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1060 GAFFNEY ROAD #7440 | ||||||||
| Address2: | COMMANDER, USA-MEDDAC-AK, ATTN: MCUC-MMD-QM | ||||||||
| City: | FT. WAINWRIGHT | ||||||||
| State: | AK | ||||||||
| PostalCode: | 997034845 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9073535418 | ||||||||
| FaxNumber: | 9073534845 | ||||||||
| Practice Location | |||||||||
| Address1: | 1060 GAFFNEY ROAD #7440 | ||||||||
| Address2: | COMMANDER, USA-MEDDAC-AK, ATTN: MCUC-MMD-QM | ||||||||
| City: | FT. WAINWRIGHT | ||||||||
| State: | AK | ||||||||
| PostalCode: | 997034845 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9073535418 | ||||||||
| FaxNumber: | 9073534845 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/29/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN527259L | PA | N | Nursing Service Providers | Registered Nurse | 163W00000X | 25011 | AK | Y | Nursing Service Providers | Registered Nurse | 163W00000X | R150185 | MD | N | Nursing Service Providers | Registered Nurse |
No ID Information.