Provider Demographics
NPI:1114490935
Name:YOUNGWORTH, RIKKI SHAWN (APRN-RNP)
Entity Type:Individual
Prefix:MS
First Name:RIKKI
Middle Name:SHAWN
Last Name:YOUNGWORTH
Suffix:
Gender:F
Credentials:APRN-RNP
Other - Prefix:
Other - First Name:RIKKI
Other - Middle Name:SHAWN
Other - Last Name:LAMM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15239 N 104TH PL
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-8563
Mailing Address - Country:US
Mailing Address - Phone:480-747-7473
Mailing Address - Fax:
Practice Address - Street 1:15239 N 104TH PL
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-8563
Practice Address - Country:US
Practice Address - Phone:480-747-7473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-03
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ219381363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily