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NPI Code Detail

MEDICARE: MACIE WALLACE RICKETTS NP

MEDICARE: MACIE WALLACE RICKETTS NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse Practitioner1234567NC

General Provider Information

NPI Number : 1013855790
Entity Type Code : Individual
Provider Name (Legal Business Name) : MACIE WALLACE RICKETTS NP
Provider Business Mailing Address
First Line : PO BOX 5105
Second Line :
City : BELFAST
State : ME
Zip : 04915-5100
Country : US
Telephone Number : 910-332-3800
Fax Number : 910-251-0421
Provider Business Practice Location Address
First Line : 2145 COUNTRY CLUB RD STE 800
Second Line :
City : JACKSONVILLE
State : NC
Zip : 28546-2404
Country : US
Telephone Number : 910-332-3800
Fax Number : 910-251-0421
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/23/2026
Last Update Date : 03/23/2026

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Directions to “ MACIE WALLACE RICKETTS NP” Practice Location

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