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General NPI Number Information
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NPI Number | 1710463856
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Entity Type | Individual
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Provider Name | LUCY RENA' MIKELL MSN, APRN, FNP-C
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Gender | Female
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Dates
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Enumeration Date | 07/12/2018
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Last Update Date | 01/28/2026
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Provider Practice Location Address
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Address Line | 1038 NORTHWEST AVE
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City | MCCOMB
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State | MS
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Zip | 39648-2116
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Country | US
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Telephone | 601-730-7012
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Fax |
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Provider Business Mailing Address
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Address Line | 106 POINTE DR
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City | SUMMIT
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State | MS
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Zip | 39666-5672
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Country | US
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Telephone | 601-551-7499
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 902573
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | AP10101
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License Number State | LA
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