Provider Demographics
NPI:1508043050
Name:BOTTOM, MICKEY SUE
Entity Type:Individual
Prefix:MRS
First Name:MICKEY
Middle Name:SUE
Last Name:BOTTOM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3013 S MISSION ST
Mailing Address - Street 2:
Mailing Address - City:ANADARKO
Mailing Address - State:OK
Mailing Address - Zip Code:73005-6200
Mailing Address - Country:US
Mailing Address - Phone:405-247-5301
Mailing Address - Fax:
Practice Address - Street 1:3013 S MISSION ST
Practice Address - Street 2:
Practice Address - City:ANADARKO
Practice Address - State:OK
Practice Address - Zip Code:73005-6200
Practice Address - Country:US
Practice Address - Phone:405-247-5301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-28
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant