Provider Demographics
NPI:1902383573
Name:MICKEY, LEXI LYNN (AGDNP-C)
Entity Type:Individual
Prefix:
First Name:LEXI
Middle Name:LYNN
Last Name:MICKEY
Suffix:
Gender:F
Credentials:AGDNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25852 N DESERT MESA DR
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85387-6823
Mailing Address - Country:US
Mailing Address - Phone:701-690-9933
Mailing Address - Fax:
Practice Address - Street 1:5681 W BEVERLY LN STE 100
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-9802
Practice Address - Country:US
Practice Address - Phone:480-443-8400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-25
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP11501363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology