Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 174N00000X | Lactation Consultant | L-301926 |
NPI | 1083206874 |
---|---|
Provider Name | Katelyn Ricketts |
First Address | Sherman, TX 75090-2837 |
Second Address | Sherman, TX 75090-2837 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/02/2021 |
Last Update Date | 03/02/2021 |