MEDICARE: IRMA MICKLE NP

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	AP111066	TX
2	363L00000X	Nurse Practitioner	249963	TX

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	:	1558301150
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IRMA MICKLE NP

Provider Business Mailing Address
First Line	:	9006 N NAVARRO ST STE B
Second Line	:
City	:	VICTORIA
State	:	TX
Zip	:	77904-1566
Country	:	US
Telephone Number	:	361-485-0500
Fax Number	:

Provider Business Practice Location Address
First Line	:	9006 N NAVARRO ST STE B
Second Line	:
City	:	VICTORIA
State	:	TX
Zip	:	77904-1566
Country	:	US
Telephone Number	:	361-485-0500
Fax Number	:

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

Provider Enumeration Date	:	06/08/2006
Last Update Date	:	04/08/2026

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Directions to “ IRMA MICKLE NP” Practice Location

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