Provider Demographics
NPI:1760631410
Name:POCKER, MICKI L (APRN)
Entity Type:Individual
Prefix:
First Name:MICKI
Middle Name:L
Last Name:POCKER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-272-5395
Mailing Address - Fax:502-272-5339
Practice Address - Street 1:601 S FLOYD ST STE 300
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1837
Practice Address - Country:US
Practice Address - Phone:502-629-1515
Practice Address - Fax:502-629-1545
Is Sole Proprietor?:No
Enumeration Date:2008-09-17
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3005612363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY105635OtherSIHO - LMVA
KY000023036VOtherHUMANA - LMVA
KYP00828506OtherRAILROAD MEDICARE - LMVA
KY7100072010Medicaid
KY50024344OtherPASSPORT - LMVA
KY000000735276OtherANTHEM - WOMEN'S SPECIALIST
KY1408744OtherCIGNA - LMVA
KY3721649000OtherPASSPORT ADVANTAGE - LMVA
KY000000620804OtherANTHEM - LMVA
IN200947930Medicaid
KY00533142Medicare PIN