Healthcare Provider Details

I. General information

NPI: 1750640363
Provider Name (Legal Business Name): NICOLA RICKETTS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2012
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6916 MONTGOMERY BLVD NE STE B-9
ALBUQUERQUE NM
87109-1489
US

IV. Provider business mailing address

8206 LOUISIANA BLVD NE STE A
ALBUQUERQUE NM
87113-1738
US

V. Phone/Fax

Practice location:
  • Phone: 505-487-2802
  • Fax:
Mailing address:
  • Phone: 505-487-2802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number88123
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberNP712978
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: