Provider Demographics
NPI:1275140972
Name:RICKERD, STACY KIT (DNP, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:KIT
Last Name:RICKERD
Suffix:
Gender:
Credentials:DNP, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 E OSBORN RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-5309
Mailing Address - Country:US
Mailing Address - Phone:602-604-0000
Mailing Address - Fax:602-604-5863
Practice Address - Street 1:1667 N TREKELL RD STE 103
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-2731
Practice Address - Country:US
Practice Address - Phone:520-876-5833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-26
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ255641363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ23355143OtherNCSBN
AZ255641OtherAZ STATE BOARD OF NURSING