Provider Demographics
NPI:1922291327
Name:DUOS, MICKEY ROSS (APRN, BC)
Entity Type:Individual
Prefix:
First Name:MICKEY
Middle Name:ROSS
Last Name:DUOS
Suffix:
Gender:M
Credentials:APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3311 PRESCOTT RD STE 100
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-3917
Mailing Address - Country:US
Mailing Address - Phone:318-442-3384
Mailing Address - Fax:318-442-3385
Practice Address - Street 1:3311 PRESCOTT RD STE 100
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-3917
Practice Address - Country:US
Practice Address - Phone:318-442-3384
Practice Address - Fax:318-442-3385
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-20
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP05285363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1023671Medicaid