Provider Demographics
NPI:1326820895
Name:RICKETTS, KATRINA JANE (FNP-C)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:JANE
Last Name:RICKETTS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:KATRINA
Other - Middle Name:JANE
Other - Last Name:MONTGOMERY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:520 MARY ST STE 520
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47710-1682
Mailing Address - Country:US
Mailing Address - Phone:812-424-8231
Mailing Address - Fax:812-435-8794
Practice Address - Street 1:520 MARY ST STE 520
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47710-1682
Practice Address - Country:US
Practice Address - Phone:812-424-8231
Practice Address - Fax:812-435-8794
Is Sole Proprietor?:No
Enumeration Date:2023-10-18
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28201849A363LF0000X
IN71014723A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN28201849AOtherREGISTERED INDIANA NURSING LICENSE
KY7100949430Medicaid
IN1103804757OtherANTHEM BCBS
IN300084520Medicaid
KY1133226OtherREGISTERED KENTUCKY NURSING LICENSE
INF11230253OtherFNP CERT
IN71014723AOtherIN STATE LICENSE
IN71014723BOtherIN CSR