MEDICARE: MICHAEL DAVE MCVICKER SR. FNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	RN120320	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023011343
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL DAVE MCVICKER SR. FNP-BC

Provider Business Mailing Address
First Line	:	HC 67 BOX 76
Second Line	:
City	:	MOUNTAIN VIEW
State	:	MO
Zip	:	65548-9005
Country	:	US
Telephone Number	:	417-934-5055
Fax Number	:

Provider Business Practice Location Address
First Line	:	220 N ELM ST
Second Line	:
City	:	MOUNTAIN VIEW
State	:	MO
Zip	:	65548-8644
Country	:	US
Telephone Number	:	417-934-2273
Fax Number	:	417-934-2232

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	04/06/2020

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