Individual
KATHLEEN DEKOVEN MCMICKEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
2250 OSPREY BLVD, STE 100, BARTOW, FL 33830
(863) 533-7151
(863) 533-7214
Mailing address
PO BOX 95004, LAKELAND, FL 33804
(863) 680-7206
(863) 680-7420
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
ARNP528982
FL
Other
Enumeration date
02/06/2006
Last updated
10/31/2007
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