Provider Demographics
NPI:1851809230
Name:HUBBARD, MICAH NICOLE (APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:MICAH
Middle Name:NICOLE
Last Name:HUBBARD
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 S JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:AVA
Mailing Address - State:MO
Mailing Address - Zip Code:65608-5530
Mailing Address - Country:US
Mailing Address - Phone:417-812-8800
Mailing Address - Fax:
Practice Address - Street 1:133 S JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:AVA
Practice Address - State:MO
Practice Address - Zip Code:65608-5530
Practice Address - Country:US
Practice Address - Phone:417-812-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-18
Last Update Date:2021-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018001741363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily