Healthcare Provider Details

I. General information

NPI: 1285187930
Provider Name (Legal Business Name): MICAH ANTHONY LADNER FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2016
Last Update Date: 11/16/2022
Certification Date: 11/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4402 E ALOHA DR SUITE 15
DIAMONDHEAD MS
39525-3349
US

IV. Provider business mailing address

1514 JEFFERSON HWY
NEW ORLEANS LA
70121-2429
US

V. Phone/Fax

Practice location:
  • Phone: 228-364-9001
  • Fax:
Mailing address:
  • Phone: 504-842-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number901609
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: