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NPI Code Detail

MEDICARE: MISS ERICKA M MICOU NP

MEDICARE: MISS ERICKA M MICOU 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
1363LC1500XCommunity Health Nurse Practitioner363L00000XMS

Other Identifiers

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

General Provider Information

NPI Number : 1568598027
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS ERICKA M MICOU NP
Provider Business Mailing Address
First Line : 1134 WINTER ST
Second Line :
City : JACKSON
State : MS
Zip : 39204-2841
Country : US
Telephone Number : 601-948-5572
Fax Number : 601-914-3012
Provider Business Practice Location Address
First Line : 1134 WINTER ST
Second Line :
City : JACKSON
State : MS
Zip : 39204-2841
Country : US
Telephone Number : 601-948-5572
Fax Number : 601-914-3012
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/26/2007
Last Update Date : 07/08/2007

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Directions to “ MISS ERICKA M MICOU NP” Practice Location

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