Provider Demographics
NPI:1154668507
Name:MICKLE, LINDA ANN (ANP, PMHCNS)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:ANN
Last Name:MICKLE
Suffix:
Gender:F
Credentials:ANP, PMHCNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 CHAMA ST NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-7120
Mailing Address - Country:US
Mailing Address - Phone:831-252-7020
Mailing Address - Fax:
Practice Address - Street 1:622 MANZANO ST NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-6302
Practice Address - Country:US
Practice Address - Phone:831-252-7020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-04
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP02121363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health