MEDICARE: CARLY ANN MICEK

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	171400000X	Health & Wellness Coach	QSSS85IEQY
2	133N00000X	Nutritionist

General Provider Information

NPI Number	:	1548149180
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLY ANN MICEK

Provider Business Mailing Address
First Line	:	9373 MORNING GLORY LN
Second Line	:
City	:	HIGHLANDS RANCH
State	:	CO
Zip	:	80130-4494
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2525 15TH ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80211-3989
Country	:	US
Telephone Number	:	859-779-0419
Fax Number	:

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

Provider Enumeration Date	:	08/28/2025
Last Update Date	:	08/28/2025

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Directions to “ CARLY ANN MICEK ” Practice Location

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