Provider Demographics
NPI:1710463856
Name:MIKELL, LUCY RENA' (MSN, FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:LUCY
Middle Name:RENA'
Last Name:MIKELL
Suffix:
Gender:F
Credentials:MSN, FNP-C
Other - Prefix:MRS
Other - First Name:LUCY
Other - Middle Name:RENA'
Other - Last Name:SIMMONS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP-C
Mailing Address - Street 1:804 ROBB STREET
Mailing Address - Street 2:
Mailing Address - City:SUMMIT
Mailing Address - State:MS
Mailing Address - Zip Code:39666
Mailing Address - Country:US
Mailing Address - Phone:601-276-7665
Mailing Address - Fax:601-276-7556
Practice Address - Street 1:804 ROBB STREET
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:MS
Practice Address - Zip Code:39666
Practice Address - Country:US
Practice Address - Phone:601-276-7665
Practice Address - Fax:601-276-7556
Is Sole Proprietor?:No
Enumeration Date:2018-07-12
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS902573363L00000X
LAAP10101363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS08520383Medicaid