Individual
MRS. TAYLOR KANE RICKENBAKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
144 S GUM AVE, VIRGINIA BEACH, VA 23452-1221
(229) 291-1727
Mailing address
144 S GUM AVE, VIRGINIA BEACH, VA 23452-1221
(229) 291-1727
Taxonomy
Speciality
Code
Description
License number
State
246ZS0410X
Surgical Technologist
—
—
363AS0400X
Surgical Physician Assistant
Primary
0110007929
VA
363AS0400X
Surgical Physician Assistant
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/15/2013
Last updated
01/19/2022
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