KRISTEN MICKKELSEN PMHNP BC LLC (NPI# 1528502002) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1528502002 |
| Entity Type | Organization |
| Organization Name | KRISTEN MICKKELSEN PMHNP BC LLC |
| Practice Address |
1321 Washington Ave Suite 304 Portland ME 04103-3636 |
| Mailing Address |
106 Sunset Rd Falmouth ME 04105-2490 |
| Practice Telephone | 2075363088 |
| Practice Fax Number | 2075363092 |
| Mailing Telephone | 2075363088 |
| Mailing Fax Number | 2075363092 |
| Enumeration Date | 2016-12-19 |
| Last Update Date | 2016-12-19 |
| Authorized Official Name | KRISTIN A MIKKELSEN (OWNER) |
| Authorized Official Telephone | 2075363088 |
| Authorized Official Credential | PMHNP |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
CNP121069 | ME | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
1321 WASHINGTON AVE SUITE 304 |
| City | PORTLAND |
| State | ME |
| Zip Code | 04103-3636 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902850589 | Longview Psychotherapy PC | Social Worker | 1321 Washington Ave, Suite 304, Portland, ME 04103-3636 | 2006-05-19 |
| 1578958294 | Jada L Kouba | Counselor | 1321 Washington Ave, Suite 312, Portland, ME 04103-3636 | 2015-03-31 |
| 1710399506 | Michelle Atienza | Nurse Practitioner | 1321 Washington Ave, Portland, ME 04103-3636 | 2014-05-28 |
| 1659782993 | Sean Murphy | Chiropractor | 1321 Washington Ave, Suite 212, Portland, ME 04103-3636 | 2014-05-08 |
| 1568872802 | Daly Grace Pa | Chiropractor | 1321 Washington Ave, Suite 212, Portland, ME 04103-3636 | 2014-05-07 |
| 1518304872 | Dialectical and Cognitive Behavioral Therapy of Nh, Pllc | Community/Behavioral Health | 1321 Washington Ave, Suite 304, Portland, ME 04103-3636 | 2013-05-28 |
| 1497096051 | Jennifer A Blanchette | Psychologist | 1321 Washington Ave, Portland, ME 04103-3654 | 2013-03-07 |
| 1336484369 | Yvonne L. Decory M.d., P.a. | Psychiatry & Neurology | 1321 Washington Ave, Suite 304, Portland, ME 04103-3636 | 2012-12-03 |
| 1407150303 | Lauren Herdrich | Counselor | 1321 Washington Ave, Portland, ME 04103-3636 | 2011-01-06 |
| 1538291356 | Joseph M Hayes | Chiropractor | 1321 Washington Ave, Suite 212, Portland, ME 04103-3636 | 2007-03-09 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790302677 | Hope for All Community Services LLC | Community/Behavioral Health | 68 Bishop St, Building 1, Unit 1, Portland, ME 04103 | 2020-06-26 |
| 1982251435 | Hope Home Healthcare, LLC | Home Health | 68 Bishop St Unit 3 #2, Portland, ME 04103 | 2019-08-20 |
| 1992367023 | Care for Everyone | In Home Supportive Care | 68 Bishop Street, Unit 1, Room 5, Portland, ME 04103 | 2019-06-28 |
| 1093373458 | Emanuel Nistrian | Student in an Organized Health Care Education/Training Program | Une, 716 Stevens Ave., Portland, ME 04103 | 2019-05-31 |
| 1023676483 | Robert Montague | Student in an Organized Health Care Education/Training Program | University of New England, 716 Stevens Ave, Portland, ME 04103 | 2019-05-31 |
| 1154838027 | Kimberly Therriault | Behavior Technician | 527 Ocean Ave Ste 19, Portland, ME 04103 | 2018-01-02 |
| 1285147918 | Teresa Maalouf | Community Health Worker | 23 Cambridge St., Portland, ME 04103 | 2017-11-16 |
| 1578082244 | Darcelle Kay Stillman | Occupational Therapist | 90 Dorothy St, Portland, ME 04103 | 2017-09-14 |
| 1821524943 | Engility Enterprises LLC | Case Management | 1 Coast Lane, Portland, ME 04103 | 2017-05-10 |
| 1720524283 | Hannah Rose Kazilionis | Counselor | 257 Deering Ave # 204, Portland, ME 04103 | 2017-01-09 |
| Find all providers in zip 04103 | ||||
| Taxonomy Code | 363LP0808X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Psych/Mental Health |
| Definition to come... |
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| 1457967325 | Megan L Langworthy | Nurse Practitioner | 1914 Se 46th Ave, Portland, OR 97215-3148 | 2020-09-16 |
| 1104446681 | Skycloud Psychiatry LLC | Nurse Practitioner | 106 South West Woods St, Portland, OR 97201 | 2020-04-24 |
| 1730712290 | Lucy Anne Bloedon | Nurse Practitioner | 4020 Sw Iowa St, Portland, OR 97221-3423 | 2020-02-12 |
| 1346802733 | Compass Psychiatric Wellness LLC | Nurse Practitioner | 4300 Ne Fremont St Ste 260, Portland, OR 97213-1100 | 2019-07-05 |
| 1548721871 | Cooke Therapy Pllc | Nurse Practitioner | 1125 Se Madison St Ste 102, Portland, OR 97214-3600 | 2019-03-28 |
| 1245719541 | Scott J Whited | Nurse Practitioner | 216 Vaughan St., Mcgeachy Hall, Portland, ME 04101 | 2018-08-08 |
| 1467969220 | Nw Mind-body Wellness, LLC | Nurse Practitioner | 16986 Nw Lynch Ln, Portland, OR 97229-1221 | 2018-01-02 |
| 1811441348 | Anthony Hoy | Nurse Practitioner | 5562 Se Pine St, Portland, OR 97215-1276 | 2016-08-12 |
| 1700241254 | Jacqueline J Cole | Nurse Practitioner | 5228 Ne Hoyt St Ste 300, Portland, OR 97213-3055 | 2015-12-29 |
| Find all providers in PORTLAND | ||||
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| 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.