Provider Demographics
NPI:1013673912
Name:JEWELL, RICKY JAMES (DNP, PMHNP)
Entity Type:Individual
Prefix:DR
First Name:RICKY
Middle Name:JAMES
Last Name:JEWELL
Suffix:
Gender:M
Credentials:DNP, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 PARSONAGE RD STE 410
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08837-2475
Mailing Address - Country:US
Mailing Address - Phone:732-659-9524
Mailing Address - Fax:732-205-1808
Practice Address - Street 1:10 PARSONAGE RD STE 410
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08837-2475
Practice Address - Country:US
Practice Address - Phone:732-659-9524
Practice Address - Fax:732-205-1808
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-15
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01229900363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health