Provider Demographics
NPI:1114982162
Name:MICKEY, KATHLEEN M (RN)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:M
Last Name:MICKEY
Suffix:
Gender:F
Credentials:RN
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Mailing Address - Street 1:601 E HAMPDEN AVE
Mailing Address - Street 2:# 430
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80113-3781
Mailing Address - Country:US
Mailing Address - Phone:303-788-8355
Mailing Address - Fax:303-788-4448
Practice Address - Street 1:601 E HAMPDEN AVE
Practice Address - Street 2:# 430
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-3781
Practice Address - Country:US
Practice Address - Phone:303-788-8355
Practice Address - Fax:303-788-4448
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO44973363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
COS13292Medicare UPIN
COC398048Medicare PIN