Provider Demographics
NPI:1790728293
Name:RICKETTS, CAROLYN (RDCS, RDMS, RVT, ARR)
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:
Last Name:RICKETTS
Suffix:
Gender:F
Credentials:RDCS, RDMS, RVT, ARR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9022 LUCKY RD
Mailing Address - Street 2:
Mailing Address - City:MC MINNVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37110-4486
Mailing Address - Country:US
Mailing Address - Phone:931-934-2020
Mailing Address - Fax:931-934-2026
Practice Address - Street 1:9022 LUCKY RD
Practice Address - Street 2:
Practice Address - City:MC MINNVILLE
Practice Address - State:TN
Practice Address - Zip Code:37110-4486
Practice Address - Country:US
Practice Address - Phone:931-934-2020
Practice Address - Fax:931-934-2026
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10577246XS1301X, 2471S1302X, 2471V0105X
TN0798662471C3402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonography
Not Answered2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiography
Not Answered2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography
Not Answered2471V0105XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular Sonography
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3790225Medicaid
TN4017629OtherBLUE CROSS BLUE SHIELD
TN3790225Medicaid