Provider Demographics
NPI:1356454896
Name:MICKLER, BARBARA A (NP)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:A
Last Name:MICKLER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:BARBARA
Other - Middle Name:A
Other - Last Name:FREEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1030 E MORGAN ST
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46151-1743
Mailing Address - Country:US
Mailing Address - Phone:812-558-0574
Mailing Address - Fax:317-530-9084
Practice Address - Street 1:1030 E MORGAN ST
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46151-1743
Practice Address - Country:US
Practice Address - Phone:812-200-2789
Practice Address - Fax:317-530-9084
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71002020A363L00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200851410Medicaid
INP01019189OtherRR MEDICARE PIN
INP01679074OtherMEDICARE RAILROAD PTAN
INP01019189OtherRR MEDICARE PIN
IN234020GMedicare PIN