Provider Demographics
NPI:1851068605
Name:SINGH-ANDERSON, MICKO S (FNP)
Entity Type:Individual
Prefix:DR
First Name:MICKO
Middle Name:S
Last Name:SINGH-ANDERSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1904 BENT OAK WAY
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-6326
Mailing Address - Country:US
Mailing Address - Phone:484-241-7714
Mailing Address - Fax:770-860-9487
Practice Address - Street 1:1904 BENT OAK WAY
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-6326
Practice Address - Country:US
Practice Address - Phone:484-241-7714
Practice Address - Fax:770-860-9487
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-27
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN198826363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily