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General NPI Number Information
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NPI Number | 1275140972
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Entity Type | Individual
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Provider Name | STACY KIT RICKERD DNP, PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 09/26/2020
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Last Update Date | 02/21/2025
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Provider Practice Location Address
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Address Line | 1667 N TREKELL RD STE 103
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City | CASA GRANDE
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State | AZ
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Zip | 85122-2731
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Country | US
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Telephone | 520-876-5833
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Fax |
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Provider Business Mailing Address
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Address Line | 1515 E OSBORN RD
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City | PHOENIX
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State | AZ
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Zip | 85014-5309
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Country | US
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Telephone | 602-604-0000
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Fax | 602-604-5863
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 255641
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License Number State | AZ
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