Provider Demographics
NPI:1346854676
Name:MUSICK'S MEDICAL PLLC
Entity Type:Organization
Organization Name:MUSICK'S MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/FNP-C
Authorized Official - Prefix:MRS
Authorized Official - First Name:JILLIAN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MUSICK
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:928-681-0101
Mailing Address - Street 1:1111 RIATA VALLEY ROAD STE B
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86409-3678
Mailing Address - Country:US
Mailing Address - Phone:928-681-0101
Mailing Address - Fax:833-989-2165
Practice Address - Street 1:1111 RIATA VALLEY ROAD STE B
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86409-3678
Practice Address - Country:US
Practice Address - Phone:928-681-0101
Practice Address - Fax:833-989-2165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-03
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ03D2193887OtherCLIA