Healthcare Provider Details

I. General information

NPI: 1649832437
Provider Name (Legal Business Name): TYLEE KATE RICKETT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2019
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 OSTRUM ST
BETHLEHEM PA
18015-1000
US

IV. Provider business mailing address

704 SEMINOLE ST
BETHLEHEM PA
18015-1436
US

V. Phone/Fax

Practice location:
  • Phone: 610-972-3298
  • Fax:
Mailing address:
  • Phone: 928-377-9390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberMD479241
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: