Basic Information
| Provider Information | |||||||||
| NPI: | 1457369043 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RICKETTS | ||||||||
| FirstName: | HEATHER | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 900 HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | MADISONVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 424311644 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2708257224 | ||||||||
| FaxNumber: | 2708257475 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | MADISONVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 424311658 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2703263900 | ||||||||
| FaxNumber: | 2703263905 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2006 | ||||||||
| LastUpdateDate: | 12/14/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 12/14/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 01077418A | IN | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | 40327 | KY | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 01077418A | 01 | IN | INDIANA LICENSE | OTHER | 64123904 | 05 | KY | MEDICAID | 40327 | 01 | KY | MEDICAL LICENSE | OTHER | LICENSE | 01 | KY | TP720 | OTHER | 000000393400 | 01 | BCBS PROVIDER NUMBER | OTHER | 1920014 | 01 | IN | IN MEDICARE | OTHER | 201380400 | 05 | IN | MEDICAID |