Provider Demographics
NPI:1609669308
Name:BENTLEY, MICCA LYN (APRN)
Entity type:Individual
Prefix:
First Name:MICCA
Middle Name:LYN
Last Name:BENTLEY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROSE HILL
Mailing Address - State:KS
Mailing Address - Zip Code:67133-9449
Mailing Address - Country:US
Mailing Address - Phone:316-613-9014
Mailing Address - Fax:
Practice Address - Street 1:625 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ROSE HILL
Practice Address - State:KS
Practice Address - Zip Code:67133-9449
Practice Address - Country:US
Practice Address - Phone:316-613-9014
Practice Address - Fax:316-613-9014
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-26
Last Update Date:2025-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-84308-062208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice