Provider Demographics
NPI:1457369043
Name:RICKETTS, HEATHER R (MD)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:R
Last Name:RICKETTS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42431-1644
Mailing Address - Country:US
Mailing Address - Phone:270-825-7224
Mailing Address - Fax:270-825-7475
Practice Address - Street 1:4199 GATEWAY BLVD STE 2400
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-7972
Practice Address - Country:US
Practice Address - Phone:812-858-4600
Practice Address - Fax:812-858-4635
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY40327207V00000X
IN01077418A207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY40327OtherMEDICAL LICENSE
KY64123904Medicaid
000000393400OtherBCBS PROVIDER NUMBER
IN1920014OtherIN MEDICARE
IN201380400Medicaid
KYLICENSEOtherTP720
IN01077418AOtherINDIANA LICENSE
0601447Medicare PIN
0935371Medicare PIN
KY40327OtherMEDICAL LICENSE