Provider Demographics
NPI:1841090610
Name:RICKETT, MEHGAN (CPNP-PC)
Entity type:Individual
Prefix:
First Name:MEHGAN
Middle Name:
Last Name:RICKETT
Suffix:
Gender:
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1810 DORCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:ALGONQUIN
Mailing Address - State:IL
Mailing Address - Zip Code:60102-5195
Mailing Address - Country:US
Mailing Address - Phone:847-754-7644
Mailing Address - Fax:
Practice Address - Street 1:600 S RANDALL RD STE 220
Practice Address - Street 2:
Practice Address - City:ALGONQUIN
Practice Address - State:IL
Practice Address - Zip Code:60102-5937
Practice Address - Country:US
Practice Address - Phone:847-854-9402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-19
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209031958363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics