Healthcare Provider Details

I. General information

NPI: 1558846113
Provider Name (Legal Business Name): MICAH LABBE FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2018
Last Update Date: 01/29/2021
Certification Date: 01/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 E 1ST ST
ALICE TX
78332-4822
US

IV. Provider business mailing address

6181 SARATOGA BLVD UNIT 117
CORPUS CHRISTI TX
78414-2475
US

V. Phone/Fax

Practice location:
  • Phone: 361-664-0145
  • Fax:
Mailing address:
  • Phone: 361-444-5148
  • Fax: 361-444-5495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP137838
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: