Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 2004029919 | MO |
NPI | 1023264736 |
---|---|
Provider Name | Kelli J Ricketts |
First Address | Nashville, TN 37232-5100 |
Second Address | Nashville, TN 37232-5100 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2008 |
Last Update Date | 15/10/2020 |