Provider Demographics
NPI:1558890996
Name:RICKETTS, AURELIA (PMHNP)
Entity Type:Individual
Prefix:
First Name:AURELIA
Middle Name:
Last Name:RICKETTS
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:AURELIA
Other - Middle Name:
Other - Last Name:WUELFING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:102 N MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-1710
Mailing Address - Country:US
Mailing Address - Phone:626-602-8530
Mailing Address - Fax:626-597-3336
Practice Address - Street 1:102 N MADISON AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-1710
Practice Address - Country:US
Practice Address - Phone:626-602-8530
Practice Address - Fax:626-597-3336
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-08
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX849378163W00000X
CA95144709163WP0808X
CA95008067363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health