Provider Demographics
NPI:1336162031
Name:RICKARD, ROBERT WESLEY (APRN, FNP-BC)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:WESLEY
Last Name:RICKARD
Suffix:
Gender:
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2216 PADRE BLVD, SUITE B, PMB 511
Mailing Address - Street 2:
Mailing Address - City:SOUTH PADRE ISLAND
Mailing Address - State:TX
Mailing Address - Zip Code:78597
Mailing Address - Country:US
Mailing Address - Phone:956-564-0463
Mailing Address - Fax:
Practice Address - Street 1:2216 PADRE BLVD, SUITE B, PMB 511
Practice Address - Street 2:
Practice Address - City:SOUTH PADRE ISLAND
Practice Address - State:TX
Practice Address - Zip Code:78597
Practice Address - Country:US
Practice Address - Phone:956-564-0463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK220055363LF0000X
TXAP111762363LF0000X
MTNUR-APRN-LIC-127234363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX647458OtherTEXAS BOARD OF NURSE EXAM
MT127234OtherMONTANA APRN LICENSE
TX111762OtherTX APN
AK220055OtherALASKA APRN LICENSE
TX191706405Medicaid
TX191706404Medicaid
TXTXB134456Medicare PIN
TXQ64789Medicare UPIN