Provider Demographics
NPI:1326820895
Name:RICKETTS, KATRINA JANE (FNP-C)
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:JANE
Last Name:RICKETTS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:KATRINA
Other - Middle Name:JANE
Other - Last Name:MONTGOMERY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1401 PROFESSIONAL BLVD
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714-8014
Mailing Address - Country:US
Mailing Address - Phone:812-473-2060
Mailing Address - Fax:812-473-0763
Practice Address - Street 1:1401 PROFESSIONAL BLVD
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-8014
Practice Address - Country:US
Practice Address - Phone:812-473-2060
Practice Address - Fax:812-473-0763
Is Sole Proprietor?:No
Enumeration Date:2023-10-18
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4015647363L00000X
IN71014723A363LF0000X
IN28201849A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100949430Medicaid
IN71014723AOtherIN STATE LICENSE
IN71014723BOtherIN CSR
IN1103804757OtherANTHEM BCBS
IN28201849AOtherREGISTERED INDIANA NURSING LICENSE
KY1133226OtherREGISTERED KENTUCKY NURSING LICENSE
IN28207249AOtherSTATE LICENSE
IN300084520Medicaid
INF11230253OtherFNP CERT