Individual
MISS ERICKA M MICOU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1134 WINTER ST, JACKSON, MS 39204-2841
(601) 948-5572
(601) 914-3012
Mailing address
1134 WINTER ST, JACKSON, MS 39204-2841
(601) 948-5572
(601) 914-3012
Taxonomy
Speciality
Code
Description
License number
State
363LC1500X
Community Health Nurse Practitioner
Primary
363L00000X
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07450365
—
MS
Enumeration date
02/26/2007
Last updated
07/08/2007
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