Provider Demographics
NPI:1194499871
Name:RICKENBACH, ALECIA MARIE (FNP)
Entity type:Individual
Prefix:
First Name:ALECIA
Middle Name:MARIE
Last Name:RICKENBACH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1490 COMMONS CIR STE 200
Mailing Address - Street 2:
Mailing Address - City:ARGYLE
Mailing Address - State:TX
Mailing Address - Zip Code:76226-2716
Mailing Address - Country:US
Mailing Address - Phone:940-400-0083
Mailing Address - Fax:
Practice Address - Street 1:1490 COMMONS CIR STE 200
Practice Address - Street 2:
Practice Address - City:ARGYLE
Practice Address - State:TX
Practice Address - Zip Code:76226-2716
Practice Address - Country:US
Practice Address - Phone:940-400-0083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-05
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY348386363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily