Individual
MS. MARCIA JEAN RICKETSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
P.A.C.
Contact information
Practice address
216 NE 12TH ST, MOORE, OK 73160-5830
(405) 794-2530
(866) 371-6223
Mailing address
2829 CHAUCER DR, OKLAHOMA CITY, OK 73120-2804
(405) 496-8059
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
710
OK
Other
Enumeration date
07/06/2006
Last updated
06/17/2009
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