MR. TRACY D. MICKELSEN


Address: 3015 E Magic View Dr, Meridian, ID 83642-3743
Phone: 2088552410

MR. TRACY D. MICKELSEN (NPI# 1801073655) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1801073655
Entity Type Individual
Full Name MR. TRACY D. MICKELSEN
Credential CSFA
Practice Address 3015 E Magic View Dr
Meridian
ID 83642-3743
Practice Telephone 2088552410
Practice Fax Number 2084825515
Mailing Telephone 2088552410
Mailing Fax Number 2084825515
Enumeration Date 2008-01-23
Last Update Date 2017-12-07
Gender Code M
Is Sole Proprietor Y

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 363AS0400X Physician Assistant
Specialization: Surgical Technologist
178692 ID Physician Assistants & Advanced Practice Nursing Providers

Office Location

Street Address 3015 E MAGIC VIEW DR
City MERIDIAN
State ID
Zip Code 83642-3743

Providers in the same location

NPI Name Taxonomy Address Enumeration
1629686720 Hope Elizabeth Whitman Physical Therapist 3015 E Magic View Dr, Meridian, ID 83642-3743 2020-07-15
1245778208 Direct Orthopedic Care LLC Orthopaedic Surgery 3015 E Magic View Dr, Ste 115, Meridian, ID 83642-3757 2017-02-09
1356893549 Jennifer Raun Lucas Physician Assistant 3015 E Magic View Dr, Meridian, ID 83642-3757 2016-11-04
1760840987 Allied Orthopaedics, LLC Orthopaedic Surgery 3015 E Magic View Dr, Suite 120, Meridian, ID 83642-3743 2016-02-02
1598190571 Chelsea Leigh Beyers Physical Therapist 3015 E Magic View Dr, Suite 100, Meridian, ID 83642-3757 2013-09-09

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1174145684 Ikdo South Meridian LLC Dentist 3839 E Amity Rd, Meridian, ID 83642 2020-05-07
1073133328 Prescription Pad LLC Pharmacy 885 S Vanguard Way, Meridian, ID 83642 2020-04-16
1609412683 Meridian Advanced Psychiatry, LLC Psychiatry & Neurology 1672 S Woodsage Ave., Meridan, ID 83642 2019-11-25
1194378927 Sergey Tsema Occupational Therapist 1259 E Pisa St, Meridian, ID 83642 2019-07-21
1003478629 Chris R Jackson Dentist Isu Family Dentistry, 1311 E Central Dr, Meridian, ID 83642 2019-07-03
1285293118 Morgan Family Medicine Nurse Practitioner 1660 S Woodsage Avenue, Meridian, ID 83642 2019-06-13
1033772793 Nugen Healthcare, Pllc Registered Nurse 2177 S Spoonbill Ave, Meridian, ID 83642 2019-04-18
1811471790 Courtney Crossland Physician Assistant 4949 S Hillsdale Ave., Meridian, ID 83642 2018-09-18
1841771938 Katelyn Perry Counselor 2068 S. Eagle Rd., Meridian, ID 83642 2018-08-27
1114406204 Gem Prep: Meridian LLC Case Management 2750 E.gala Ct., Meridian, ID 83642 2018-08-09
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Taxonomy Information

Taxonomy Code 363AS0400X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Physician Assistant
Specialization Surgical Technologist

Taxonomy Definition

Definition to come...

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1982937066 Don H Curtis Physician Assistant 348 W Bloomington Dr, Meridian, ID 83642-6942 2009-09-08
1245789536 Lauren Galligar Physician Assistant 3399 E Louise Dr, Meridian, ID 83642-5047 2016-09-27
1780086249 Abby M Thames Physician Assistant 1521 A 22nd Avenue, Meridian, MS 39301 2014-09-16
1447688312 Anne M Peterson Physician Assistant 3399 E Louise Dr, Ste 400, Meridian, ID 83642-5047 2013-10-31
1093853871 William B Curtis Physician Assistant 520 S Eagle Rd, Suite 1201, Meridian, ID 83642-6308 2007-02-02
1497850424 Lori Mcmullen Physician Assistant 2111 14th St, Meridian, MS 39301-4041 2006-09-14

Providers in the same taxonomy and state

NPI Name Taxonomy Address Enumeration
1881218089 Michael Keegan Huntsman Physician Assistant 730 Aspen Ave, Shelley, ID 83274-1400 2020-06-03
1700447141 Katie Elizabeth Nichols Physician Assistant 1072 N Liberty St Ste 201, Boise, ID 83704 2019-06-26
1831647197 Nicholas Hensley Physician Assistant 3155 Channing Way Ste B, Idaho Falls, ID 83404-7534 2016-09-15
1811369549 Anna Stoia Physician Assistant 4401 E. Tuscany Ave., Nampa, ID 83686 2015-10-21
1356437172 Clare Elizabeth York Physician Assistant 805 Main St., Salmon, ID 83467 2006-10-05
1891707618 Brian Keith Lachapelle Physician Assistant 6140 W Curtisan, Ste 102, Boise, ID 83704 2006-08-12
1992743215 Bill Stahlberg Physician Assistant 211 Forest St, Mccall, ID 83638-5256 2006-06-02
1780641530 Alicia R Borst Physician Assistant 3960 W. Wainwright, Boise, ID 83713 2006-04-26
1275047409 Alexx Sliman Physician Assistant 425 Idaho St, Gooding, ID 83330-1258 2017-11-27
1487168118 Kami Bowcut Physician Assistant 700 W Ironwood Dr Ste 341, Coeur D Alene, ID 83814-4404 2017-11-16
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Competitor

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City MERIDIAN
Zip Code 83642

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Dataset Information

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.

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