Healthcare Provider Details

I. General information

NPI: 1053953794
Provider Name (Legal Business Name): MICA LADON NORMAN PMHNP-BC, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2019
Last Update Date: 10/13/2025
Certification Date: 10/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 WILSON ST
HENDERSON TX
75652-5956
US

IV. Provider business mailing address

300 WILSON ST
HENDERSON TX
75652-5956
US

V. Phone/Fax

Practice location:
  • Phone: 903-655-6536
  • Fax: 903-657-6072
Mailing address:
  • Phone: 903-655-6536
  • Fax: 903-509-5835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP143541
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP143541
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: