MEDICARE: MIKAYLA JAMES NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	2025045573	MO
2	363LF0000X	Family Nurse Practitioner	2025045573	MO

General Provider Information

NPI Number	:	1700753324
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIKAYLA JAMES NP

Provider Business Mailing Address
First Line	:	PO BOX 957683
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63195-7683
Country	:	US
Telephone Number	:	573-705-1298
Fax Number	:	573-760-8293

Provider Business Practice Location Address
First Line	:	1103 W LIBERTY ST
Second Line	:
City	:	FARMINGTON
State	:	MO
Zip	:	63640-1921
Country	:	US
Telephone Number	:	573-756-6751
Fax Number	:	573-760-8293

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2025
Last Update Date	:	12/10/2025

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