Provider Demographics
NPI:1588648695
Name:MICK, KATHERINE ANN (RN ARNP LMLP)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ANN
Last Name:MICK
Suffix:
Gender:F
Credentials:RN ARNP LMLP
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Mailing Address - Street 1:1901 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:KS
Mailing Address - Zip Code:67114
Mailing Address - Country:US
Mailing Address - Phone:316-284-6400
Mailing Address - Fax:316-284-6491
Practice Address - Street 1:1901 E 1ST ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:KS
Practice Address - Zip Code:67114
Practice Address - Country:US
Practice Address - Phone:316-284-6400
Practice Address - Fax:316-284-6491
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS13-32105-041363LP0808X
KS74118363LP0808X
KS1394103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMM0891918OtherDEA LICENSE #
WAMM0891918OtherDEA LICENSE #
160595Medicare ID - Type Unspecified