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General NPI Number Information
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NPI Number | 1356063911
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Entity Type | Individual
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Provider Name | MICKELYN GRAVES HOUGHTON APRN-CNM
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Gender | Female
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Dates
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Enumeration Date | 09/12/2022
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Last Update Date | 02/07/2024
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Provider Practice Location Address
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Address Line | 1129 N MISSOURI AVE
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City | LAKELAND
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State | FL
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Zip | 33805-4411
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Country | US
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Telephone | 866-234-8534
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Fax |
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Provider Business Mailing Address
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Address Line | 47 5TH ST NW
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City | WINTER HAVEN
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State | FL
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Zip | 33881-4672
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Country | US
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Telephone | 866-234-8534
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number | APRN11021795
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License Number State | FL
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