Provider Demographics
NPI:1932828670
Name:VICAN, MIKAYLA ELIZABETH (DNP)
Entity Type:Individual
Prefix:DR
First Name:MIKAYLA
Middle Name:ELIZABETH
Last Name:VICAN
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:6305 LONAS DR STE 101
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-3203
Mailing Address - Country:US
Mailing Address - Phone:865-588-3173
Mailing Address - Fax:865-588-3174
Practice Address - Street 1:6305 LONAS DR STE 101
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-3203
Practice Address - Country:US
Practice Address - Phone:865-588-3173
Practice Address - Fax:865-588-3174
Is Sole Proprietor?:No
Enumeration Date:2022-08-25
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN32288363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health