MRS. MIRANDA HICKLE (NPI# 1528317054) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1528317054 |
Entity Type | Individual |
Full Name | MRS. MIRANDA HICKLE |
Credential | FNP |
Practice Address |
657 E Broadway Blvd Suite D Jefferson City TN 37760-4948 |
Practice Telephone | 8653756005 |
Practice Fax Number | 8654710244 |
Mailing Telephone | 8653756005 |
Mailing Fax Number | 8654710244 |
Enumeration Date | 2012-08-30 |
Last Update Date | 2014-11-19 |
Gender Code | F |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
16752 | TN | Physician Assistants & Advanced Practice Nursing Providers |
State | Issuer | Identifier | Type Code |
---|---|---|---|
TN | 1530430 | 05 |
Street Address |
657 E BROADWAY BLVD SUITE D |
City | JEFFERSON CITY |
State | TN |
Zip Code | 37760-4948 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1639129323 | Aqueel M Kouser | Internal Medicine | 657 E Broadway Blvd, Suite C, Jefferson City, TN 37760-4948 | 2006-05-11 |
1073979522 | Jeff City Pharmacist Group LLC Dba Md Pharmacy Store 2 | Pharmacy | 657 E Broadway Blvd, Jefferson City, TN 37760 | 2016-01-13 |
1205226032 | Healthstar Physicians, PC | Internal Medicine | 657 E Broadway Blvd, Suite C, Jefferson City, TN 37760-4948 | 2015-02-02 |
1487961173 | Mountain View Pediatrics and Internal Medicine | Clinic/Center | 657 E Broadway Blvd, Jefferson City, TN 37760-4948 | 2010-09-02 |
1689846271 | Patricia Annette Waddell | Nurse Practitioner | 657 E Broadway Blvd, Suite C, Jefferson City, TN 37760-4948 | 2008-03-24 |
1285788323 | Steven Todd Sheedlo | Emergency Medicine | 657 E Broadway Blvd, Ste. C, Jefferson City, TN 37760 | 2007-01-23 |
1902820624 | Laura Kraus | Pediatrics | 657 E Broadway Blvd, Suite D, Jefferson City, TN 37760-4948 | 2006-07-26 |
1902822588 | Optimus Health Center, Inc. | Physical Therapist | 657 E Broadway Blvd, Jefferson City, TN 37760-4906 | 2006-07-15 |
1235178047 | Mathew T Kraus | Internal Medicine | 657 E Broadway Blvd, Suite D, Jefferson City, TN 37760-4948 | 2006-06-06 |
1740231646 | Debra A Lane | Family Medicine | 657 E Broadway Blvd, Healthstar Physicians Ste C, Jefferson City, TN 37760 | 2006-05-15 |
Find all providers in the same location |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1699235929 | Emmley L Cole | Nurse Practitioner | 277 E W Broadway Blvd, Jefferson, TN 37760 | 2019-03-22 |
1275044877 | Cindy Anderson | Nurse Practitioner | 277 E Broadway Blvd, Jefferson City, TN 37760 | 2017-10-23 |
1801259940 | Mcfarland Group, Inc. | Durable Medical Equipment & Medical Supplies | 665 E Broadway Blvd, Jefferson City, TN 37760 | 2016-04-04 |
1124422266 | Penny Williams-cordeiro | Nurse Practitioner | 1901 Brookside Drive, Suite 105, Kingsport, TN 37760 | 2014-10-17 |
1215363841 | Lindsey Ann Clyde | Physician Assistant | 120 Hospital Dr Ste 130, Jefferson City, TN 37760 | 2013-09-14 |
1679849814 | Allison Renee Farris | Surgery | 120 Hospital Dr Ste G20, Jefferson City, TN 37760 | 2012-03-31 |
1245562891 | Steven Jarvis Monroe | Dentist | 156 W. Broadway Blvd., Jefferson City, TN 37760 | 2010-02-08 |
1952560625 | Summit Medical Group,pllc | Internal Medicine | 380 W Broadway Blvd, Jefferson City, TN 37760 | 2008-06-06 |
1780756189 | Steven J Monroe Dds PC | Dentist | 156 W Broadway Blvd, Jefferson City, TN 37760 | 2006-11-14 |
1720188600 | Dennis U Spjut | Psychologist | 732 E Jefferson St, Dennis Spjut Phd, Jefferson City, TN 37760 | 2006-09-22 |
Find all providers in zip 37760 |
Taxonomy Code | 363LF0000X |
Grouping | Physician Assistants & Advanced Practice Nursing Providers |
Classification | Nurse Practitioner |
Specialization | Family |
Definition to come... |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1780211169 | Claire Luetkemeyer | Nurse Practitioner | 213 Michelle Dr, Jefferson City, MO 65109-0135 | 2020-03-25 |
1386104818 | Renee Jean Scherr | Nurse Practitioner | 8200 No More Victims Rd, Jefferson City, MO 65101-4539 | 2019-03-21 |
1366912362 | Julia Ann Babin | Nurse Practitioner | 1620 Bald Hill Rd, Jefferson City, MO 65101-3804 | 2018-12-03 |
1033688924 | Sara Marso | Nurse Practitioner | 2511 W Edgewood Dr Ste D, Jefferson City, MO 65109-5869 | 2018-11-20 |
1275044877 | Cindy Anderson | Nurse Practitioner | 277 E Broadway Blvd, Jefferson City, TN 37760 | 2017-10-23 |
1871897405 | Sarah Elizabeth Hyman | Nurse Practitioner | 3501a W Truman Blvd, Jefferson City, MO 65109-5715 | 2010-12-22 |
1164735221 | Kimberly F Shelton | Nurse Practitioner | 1004 N Highway 92 Ste B, Jefferson City, TN 37760-3687 | 2010-07-19 |
1235338252 | Sheila Ann Olsen | Nurse Practitioner | 806 Navajo Dr, Jefferson City, TN 37760-5122 | 2007-07-11 |
1225013907 | Sharon Mcanear | Nurse Practitioner | 1646 Russell Ave, Carson-newman College, Jefferson City, TN 37760-2204 | 2005-12-14 |
1114909538 | Betty Jo Ellington | Nurse Practitioner | 1413 Russell Ave, Jefferson City, TN 37760-2562 | 2005-11-20 |
Find all providers in JEFFERSON CITY |
City | JEFFERSON CITY |
Zip Code | 37760 |
Please comment or provide details below to improve the information on MRS. MIRANDA HICKLE.
Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.