Provider Demographics
NPI:1447682802
Name:MAZZA-RICKETTS, MARY BETH (APRN)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:BETH
Last Name:MAZZA-RICKETTS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:BETH
Other - Last Name:MAZZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:5959 S SHERWOOD FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-6038
Mailing Address - Country:US
Mailing Address - Phone:225-526-0006
Mailing Address - Fax:225-765-9291
Practice Address - Street 1:8415 GOODWOOD BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-7851
Practice Address - Country:US
Practice Address - Phone:225-765-5633
Practice Address - Fax:225-765-5634
Is Sole Proprietor?:No
Enumeration Date:2013-08-07
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA119996-7293363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics