Provider Demographics
NPI:1366868598
Name:DUCKETT, NYSHAE CULLY (PMHNP)
Entity Type:Individual
Prefix:
First Name:NYSHAE
Middle Name:CULLY
Last Name:DUCKETT
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5109
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92517-5109
Mailing Address - Country:US
Mailing Address - Phone:951-341-8930
Mailing Address - Fax:951-341-8932
Practice Address - Street 1:4960 ARLINGTON AVE
Practice Address - Street 2:SUITE B
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92504-2738
Practice Address - Country:US
Practice Address - Phone:951-341-8930
Practice Address - Fax:951-341-8932
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-12
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95004355363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health