Healthcare Provider Details

I. General information

NPI: 1750952412
Provider Name (Legal Business Name): MICAH WAYNE DUKE APRN, RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2021
Last Update Date: 01/04/2024
Certification Date: 01/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 TRAVIS RANCH BLVD STE 2
FORNEY TX
75126
US

IV. Provider business mailing address

1102 BAINBRIDGE LN
FORNEY TX
75126-6466
US

V. Phone/Fax

Practice location:
  • Phone: 469-910-5902
  • Fax:
Mailing address:
  • Phone: 940-206-5207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number772790
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number958785
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number958785
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number1107769
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number1107769
License Number StateTX
# 6
Primary TaxonomyN
Taxonomy Code363LC1500X
TaxonomyCommunity Health Nurse Practitioner
License Number1107769
License Number StateTX
# 7
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number1107769
License Number StateTX
# 8
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number1107769
License Number StateTX
# 9
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number1107769
License Number StateTX
# 10
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1107769
License Number StateTX
# 11
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number1107769
License Number StateTX
# 12
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number1107769
License Number StateTX
# 13
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1107769
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: