Provider Demographics
NPI:1013144088
Name:MCMICKEN, PAULA MOORE (CRNA)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:MOORE
Last Name:MCMICKEN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 ROAD 3 S
Mailing Address - Street 2:
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30120-5509
Mailing Address - Country:US
Mailing Address - Phone:770-382-4646
Mailing Address - Fax:
Practice Address - Street 1:180 ROAD 3 S
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-5509
Practice Address - Country:US
Practice Address - Phone:770-382-4646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-17
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN149324367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered