Provider Demographics
NPI:1154138170
Name:RICKS, ANDREW M (RN, BSN)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:M
Last Name:RICKS
Suffix:
Gender:M
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:356 LIONS ST
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:LA
Mailing Address - Zip Code:70121-3504
Mailing Address - Country:US
Mailing Address - Phone:504-615-6939
Mailing Address - Fax:
Practice Address - Street 1:1900 GRAVIER ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112-2262
Practice Address - Country:US
Practice Address - Phone:504-615-6939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-12
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA205658163WN0800X
LA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty
No163WN0800XNursing Service ProvidersRegistered NurseNeuroscience