Healthcare Provider Details

I. General information

NPI: 1952534323
Provider Name (Legal Business Name): KRISTEN ANN RICKERTSEN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2009
Last Update Date: 07/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 EAST KIMBALL STREET
CALLAWAY NE
68825-2596
US

IV. Provider business mailing address

213 EAST KIMBALL STREET
CALLAWAY NE
68825-2596
US

V. Phone/Fax

Practice location:
  • Phone: 308-836-2294
  • Fax: 308-836-2451
Mailing address:
  • Phone: 308-836-2294
  • Fax: 308-836-2451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number111241
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number96801
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: