Healthcare Provider Details

I. General information

NPI: 1801594437
Provider Name (Legal Business Name): KALEY RICKETTS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KALEY AOWN

II. Dates (important events)

Enumeration Date: 02/22/2023
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10767 E TRAVERSE HWY
TRAVERSE CITY MI
49684-6219
US

IV. Provider business mailing address

10767 E TRAVERSE HWY
TRAVERSE CITY MI
49684-6219
US

V. Phone/Fax

Practice location:
  • Phone: 231-947-1112
  • Fax: 231-947-7739
Mailing address:
  • Phone: 231-947-1112
  • Fax: 231-947-7739

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704318054
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: