Provider Demographics
NPI:1871990416
Name:RICKMAN, TIFFANY CHEYENNE
Entity type:Individual
Prefix:MS
First Name:TIFFANY
Middle Name:CHEYENNE
Last Name:RICKMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3705 COUNTY ROAD KK
Mailing Address - Street 2:
Mailing Address - City:HEREFORD
Mailing Address - State:TX
Mailing Address - Zip Code:79045-7320
Mailing Address - Country:US
Mailing Address - Phone:806-410-6113
Mailing Address - Fax:
Practice Address - Street 1:3705 COUNTY ROAD KK
Practice Address - Street 2:
Practice Address - City:HEREFORD
Practice Address - State:TX
Practice Address - Zip Code:79045-7320
Practice Address - Country:US
Practice Address - Phone:806-410-6113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-25
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXNA08985922376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide