Individual
BOBBY JEAN MICKENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
303 E BASELINE RD, PHOENIX, AZ 85042-6530
(022) 437-2776
(602) 276-4427
Mailing address
3003 N CENTRAL AVE STE 1600, PHOENIX, AZ 85012-2908
(602) 323-3344
(602) 323-3496
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
2006020259
MO
363LW0102X
Women's Health Nurse Practitioner
Primary
241811
AZ
Other
Enumeration date
06/02/2014
Last updated
07/07/2020
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