Individual
RICKY BROCKINGTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
102 FAIRVIEW DR STE B, FRANKLIN, VA 23851-1206
(757) 562-2158
(757) 516-8019
Mailing address
19124 LAKESIDE DR, COURTLAND, VA 23837-2634
(757) 562-2004
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
0024180104
VA
Other
Enumeration date
09/12/2020
Last updated
08/12/2021
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