Healthcare Provider Details

I. General information

NPI: 1346123106
Provider Name (Legal Business Name): JOHN RICKETSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2025
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76 JUDSON RD
WEYMOUTH MA
02188-1415
US

IV. Provider business mailing address

76 JUDSON RD
WEYMOUTH MA
02188-1415
US

V. Phone/Fax

Practice location:
  • Phone: 781-927-8143
  • Fax:
Mailing address:
  • Phone: 781-927-8143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2026042928
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: