Healthcare Provider Details

I. General information

NPI: 1710463856
Provider Name (Legal Business Name): LUCY RENA' MIKELL MSN, APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LUCY RENA' SIMMONS FNP-C

II. Dates (important events)

Enumeration Date: 07/12/2018
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1038 NORTHWEST AVE
MCCOMB MS
39648-2116
US

IV. Provider business mailing address

106 POINTE DR
SUMMIT MS
39666-5672
US

V. Phone/Fax

Practice location:
  • Phone: 601-730-7012
  • Fax:
Mailing address:
  • Phone: 601-551-7499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP10101
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number902573
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: