Healthcare Provider Details

I. General information

NPI: 1235579749
Provider Name (Legal Business Name): NICKI D RIPPETEAU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2013
Last Update Date: 07/24/2025
Certification Date: 07/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4606 E 184TH ST
BELTON MO
64012-8323
US

IV. Provider business mailing address

4606 E 184TH ST
BELTON MO
64012-8323
US

V. Phone/Fax

Practice location:
  • Phone: 806-674-8222
  • Fax:
Mailing address:
  • Phone: 806-674-8222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number50707
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License Number50707
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number50707
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: