MEDICARE: NICOLE MICK

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	363LP2300X	Primary Care Nurse Practitioner	246052	LA

General Provider Information

NPI Number	:	1619801446
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE MICK

Provider Business Mailing Address
First Line	:	111 HARROW DR
Second Line	:
City	:	SLIDELL
State	:	LA
Zip	:	70461-3933
Country	:	US
Telephone Number	:	985-290-4025
Fax Number	:

Provider Business Practice Location Address
First Line	:	2375 GAUSE BLVD E
Second Line	:
City	:	SLIDELL
State	:	LA
Zip	:	70461-4142
Country	:	US
Telephone Number	:	985-645-9000
Fax Number	:

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

Provider Enumeration Date	:	06/09/2026
Last Update Date	:	06/09/2026

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Directions to “ NICOLE MICK ” Practice Location

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