Provider Demographics
NPI:1487959599
Name:RICKER, KRISTI LYNNE (RN-BC, CARN)
Entity type:Individual
Prefix:
First Name:KRISTI
Middle Name:LYNNE
Last Name:RICKER
Suffix:
Gender:F
Credentials:RN-BC, CARN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 PARK ST STE 5
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-5000
Mailing Address - Country:US
Mailing Address - Phone:207-992-0411
Mailing Address - Fax:
Practice Address - Street 1:157 PARK ST STE 5
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-5000
Practice Address - Country:US
Practice Address - Phone:207-992-0411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-20
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER058098163W00000X
MERN58098163WA0400X, 163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)