Provider Demographics
NPI:1720821960
Name:NELSON, RICKY NMN
Entity type:Individual
Prefix:
First Name:RICKY
Middle Name:NMN
Last Name:NELSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:RICKY
Other - Middle Name:NMN
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:361 WALLACE AVE
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:KY
Mailing Address - Zip Code:40601-2132
Mailing Address - Country:US
Mailing Address - Phone:973-494-2979
Mailing Address - Fax:
Practice Address - Street 1:361 WALLACE AVE
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-2132
Practice Address - Country:US
Practice Address - Phone:973-494-2979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYN10999586342000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes342000000XTransportation ServicesTransportation Network Company