Provider Demographics
NPI:1518090794
Name:MIKICKI, BARBARA (MD)
Entity Type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:
Last Name:MIKICKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 FIRE STATION RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-4016
Mailing Address - Country:US
Mailing Address - Phone:931-358-4146
Mailing Address - Fax:931-358-4147
Practice Address - Street 1:560 FIRE STATION RD
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-4016
Practice Address - Country:US
Practice Address - Phone:931-358-4146
Practice Address - Fax:931-358-4147
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000026924208D00000X
KY30631208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4021038OtherBC BS OF TN
F84511Medicare UPIN
TN3092287Medicare ID - Type Unspecified
TN4021038OtherBC BS OF TN