Provider Demographics
NPI:1194613943
Name:FLICKINGER, CHARLES RICHARD (DNP)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:RICHARD
Last Name:FLICKINGER
Suffix:
Gender:M
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:627 S 12TH ST
Mailing Address - Street 2:
Mailing Address - City:SAC CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50583-2505
Mailing Address - Country:US
Mailing Address - Phone:641-430-5422
Mailing Address - Fax:
Practice Address - Street 1:620 NORTHWESTERN DR STE 1
Practice Address - Street 2:
Practice Address - City:STORM LAKE
Practice Address - State:IA
Practice Address - Zip Code:50588-2935
Practice Address - Country:US
Practice Address - Phone:712-732-5030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-27
Last Update Date:2025-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA185217363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily