Provider Demographics
NPI:1437510807
Name:RICKETT, SHELLEY P (FNP)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:P
Last Name:RICKETT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:438 SARPY CREEK RD
Mailing Address - Street 2:
Mailing Address - City:HYSHAM
Mailing Address - State:MT
Mailing Address - Zip Code:59038-9613
Mailing Address - Country:US
Mailing Address - Phone:406-581-9119
Mailing Address - Fax:
Practice Address - Street 1:383 N 17TH AVE
Practice Address - Street 2:
Practice Address - City:FORSYTH
Practice Address - State:MT
Practice Address - Zip Code:59327-7971
Practice Address - Country:US
Practice Address - Phone:406-346-2161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-14
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTNUR-APRN-LIC-102257363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily