Individual
MISS KELLY NICOLE RICKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, ATC
Contact information
Practice address
2620 EAGAN WOODS DR, EAGAN, MN 55121-1138
(651) 968-5201
Mailing address
2620 EAGAN WOODS DR, EAGAN, MN 55121-1138
(651) 968-5200
Taxonomy
Speciality
Code
Description
License number
State
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
0543
SD
2255A2300X
Athletic Trainer
Primary
3429
MN
Other
Enumeration date
09/03/2020
Last updated
06/26/2026
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