Provider Demographics
NPI:1568717072
Name:BASKETT, RICKEY JR (MD)
Entity Type:Individual
Prefix:DR
First Name:RICKEY
Middle Name:
Last Name:BASKETT
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1108 KENTWORTH DR STE 704
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:27540-3325
Mailing Address - Country:US
Mailing Address - Phone:919-552-9952
Mailing Address - Fax:919-552-3062
Practice Address - Street 1:1108 KENTWORTH DR STE 704
Practice Address - Street 2:
Practice Address - City:HOLLY SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:27540-3325
Practice Address - Country:US
Practice Address - Phone:919-552-9952
Practice Address - Fax:919-552-3062
Is Sole Proprietor?:No
Enumeration Date:2012-07-20
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2015-01395207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine