Healthcare Provider Details

I. General information

NPI: 1023011343
Provider Name (Legal Business Name): MICHAEL DAVE MCVICKER SR. FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 04/06/2020
Certification Date: 04/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 N ELM ST
MOUNTAIN VIEW MO
65548-8644
US

IV. Provider business mailing address

HC 67 BOX 76
MOUNTAIN VIEW MO
65548-9005
US

V. Phone/Fax

Practice location:
  • Phone: 417-934-2273
  • Fax: 417-934-2232
Mailing address:
  • Phone: 417-934-5055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN120320
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: