Provider Demographics
NPI:1710487897
Name:FICKES, PAUL DANIEL (PMHNP-BC)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:DANIEL
Last Name:FICKES
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:724 S CENTRAL AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-7808
Mailing Address - Country:US
Mailing Address - Phone:541-249-7244
Mailing Address - Fax:541-325-4055
Practice Address - Street 1:724 S CENTRAL AVE STE 101
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-7808
Practice Address - Country:US
Practice Address - Phone:541-789-4222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-15
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201805705NP-PP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR201805705NP-PPOtherOREGON STATE BOARD OF NURSING