Provider Demographics
NPI:1396492922
Name:MIKOL, KATHRYN JEAN (MSN, APRN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:JEAN
Last Name:MIKOL
Suffix:
Gender:F
Credentials:MSN, APRN, PMHNP-BC
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:JEAN
Other - Last Name:MYROLD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2634 ORMOND RD
Mailing Address - Street 2:
Mailing Address - City:WHITE LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48383-2139
Mailing Address - Country:US
Mailing Address - Phone:424-388-4657
Mailing Address - Fax:
Practice Address - Street 1:308 W 15TH ST
Practice Address - Street 2:
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-2038
Practice Address - Country:US
Practice Address - Phone:270-660-8866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-03
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704294787NSA230DC363LP0808X
KY4004535363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY4004535Medicaid