Active NPI
Kristen Ricketts
- Physical Therapist
- Fort Smith, AR
National Provider Identifier
1487727558
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT 2975
- Practice address
- 3304 S M St
Fort Smith, AR 72903-2903 - Phone
- (479) 785-4677
- NPI assigned
- Nov 16, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | PTA 2008 | AR | |
| Physical Therapist | 225100000X | PT 2975 | AR | Primary |
Addresses
Primary practice location
3304 S M St
Fort Smith, AR 72903-2903
Mailing address
221A N 44TH St
Fort Smith, AR 72903-2370
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5A318 | Other | AR | BLUE CROSS BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT 2975 | AR | MD | Physical Therapist |
| PTA 2008 | AR | MD | Physical Therapy Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| The Gregory Kistler Treatment Center, Inc. | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Voluntary or Charitable Agency
- Fort Smith, AR
- NPI 1437118015
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163635200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1185494400000",
"number": "1487727558",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "221A N 44TH ST",
"city": "FORT SMITH",
"state": "AR",
"postal_code": "729032370"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3304 S M ST",
"city": "FORT SMITH",
"state": "AR",
"postal_code": "729032903",
"telephone_number": "479-785-4677"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RICKETTS",
"first_name": "KRISTEN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-11-16",
"last_updated": "2007-07-27",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "AR",
"license": "PTA 2008",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "AR",
"license": "PT 2975",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "5A318",
"state": "AR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fort Smith, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.