Provider Demographics
NPI:1821843285
Name:RICKETTS, DIANA (PMHNP)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:RICKETTS
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 E LAMAR BLVD STE 214
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76011-4464
Mailing Address - Country:US
Mailing Address - Phone:469-463-6202
Mailing Address - Fax:682-316-9194
Practice Address - Street 1:1601 E LAMAR BLVD STE 214
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011-4464
Practice Address - Country:US
Practice Address - Phone:469-463-6202
Practice Address - Fax:682-316-9194
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-19
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1112434363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health