MEDICARE: ANGELA DRAUGHON RICKELTON CRNA

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
1	367500000X	Certified Registered Nurse Anesthetist	51813	IL
2	163W00000X	Registered Nurse	144978	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508836297
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA DRAUGHON RICKELTON CRNA

Provider Business Mailing Address
First Line	:	PO BOX 26595
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27415-6595
Country	:	US
Telephone Number	:	336-832-7786
Fax Number	:	336-272-4063

Provider Business Practice Location Address
First Line	:	509 N ELAM AVE
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27403-1118
Country	:	US
Telephone Number	:	336-832-0900
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/25/2006
Last Update Date	:	09/11/2025

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