Individual
JOHN M RICKETTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1231 1ST ST, KENNETT, MO 63857-2527
(573) 888-4522
Mailing address
209 S MAIN ST, POPLAR BLUFF, MO 63901-5831
(573) 686-5550
(573) 686-2139
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
060608
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1053520874
—
MO
05
—
145737701
—
AR
Enumeration date
05/21/2007
Last updated
08/06/2014
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