Provider Demographics
NPI:1871302273
Name:MYERS, RICKY
Entity type:Individual
Prefix:
First Name:RICKY
Middle Name:
Last Name:MYERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 102
Mailing Address - Street 2:
Mailing Address - City:BLUE HILL
Mailing Address - State:NE
Mailing Address - Zip Code:68930-0102
Mailing Address - Country:US
Mailing Address - Phone:269-953-2030
Mailing Address - Fax:
Practice Address - Street 1:614 W CASS ST # B102
Practice Address - Street 2:
Practice Address - City:BLUE HILL
Practice Address - State:NE
Practice Address - Zip Code:68930-5514
Practice Address - Country:US
Practice Address - Phone:269-953-2030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-01
Last Update Date:2025-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist