Healthcare Provider Details

I. General information

NPI: 1437510807
Provider Name (Legal Business Name): SHELLEY P RICKETT NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2016
Last Update Date: 06/14/2024
Certification Date: 06/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

383 N 17TH AVE
FORSYTH MT
59327-7971
US

IV. Provider business mailing address

438 SARPY CREEK RD
HYSHAM MT
59038-9613
US

V. Phone/Fax

Practice location:
  • Phone: 406-346-2161
  • Fax:
Mailing address:
  • Phone: 406-581-9119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNUR-APRN-LIC-102257
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberNUR-APRN-LIC-102257
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: