Healthcare Provider Details

I. General information

NPI: 1427886209
Provider Name (Legal Business Name): MICKEY MICHELLE FOX FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2024
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12830 HESPERIA RD STE A-D
VICTORVILLE CA
92395-7788
US

IV. Provider business mailing address

12830 HESPERIA RD STE A-D
VICTORVILLE CA
92395-7788
US

V. Phone/Fax

Practice location:
  • Phone: 760-684-8999
  • Fax: 760-684-8111
Mailing address:
  • Phone: 760-684-8999
  • Fax: 760-684-8111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95031507
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number95109643
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: