Provider Demographics
NPI:1326641499
Name:RICKETTS, ASHLEY ANN (DNP PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:ANN
Last Name:RICKETTS
Suffix:
Gender:F
Credentials:DNP PMHNP-BC
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:ANN
Other - Last Name:RICKETTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ASHLEY ANN MOULIN
Mailing Address - Street 1:105 SWEETBRIAR LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-1736
Mailing Address - Country:US
Mailing Address - Phone:502-216-9458
Mailing Address - Fax:
Practice Address - Street 1:105 SWEETBRIAR LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-1736
Practice Address - Country:US
Practice Address - Phone:502-216-9458
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-19
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3015479363LP0808X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300058423Medicaid
KY7100719600Medicaid