Provider Demographics
NPI:1477683985
Name:RICKETTS, BEVERLY (PNP)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:
Last Name:RICKETTS
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10663 E AUTUMN SAGE DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-8830
Mailing Address - Country:US
Mailing Address - Phone:480-563-2109
Mailing Address - Fax:
Practice Address - Street 1:4633 E CHANDLER BLVD STE 100
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048-0431
Practice Address - Country:US
Practice Address - Phone:480-776-0440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN031459163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics