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General NPI Number Information
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NPI Number | 1891265021
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Entity Type | Individual
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Provider Name | JADELLA AMANDA MICKLER AGACNP-BC
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Gender | Female
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Dates
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Enumeration Date | 11/30/2018
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Last Update Date | 03/19/2025
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Provider Practice Location Address
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Address Line | 2001 CRYSTAL SPRING AVE SW STE 201
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City | ROANOKE
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State | VA
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Zip | 24014-2465
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Country | US
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Telephone | 540-853-0100
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Fax |
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Provider Business Mailing Address
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Address Line | 213 S JEFFERSON ST STE 1006
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City | ROANOKE
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State | VA
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Zip | 24011-1713
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Country | US
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Telephone | 540-224-5353
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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 | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | RN222049
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363LC0200X
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Taxonomy Name | Critical Care Medicine Nurse Practitioner
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License Number | RN222049
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 1172742
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License Number State | AL
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Taxonomy #4
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Taxonomy Code | 363LC0200X
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Taxonomy Name | Critical Care Medicine Nurse Practitioner
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License Number | 1172742
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License Number State | AL
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Taxonomy #5
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 0024192859
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License Number State | VA
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