Individual
JESSICA MICKUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
5949 SHERRY LN STE 1150, DALLAS, TX 75225-8066
(888) 808-6651
Mailing address
6061 ELSOLANO DR APT 14302, FORT WORTH, TX 76137-3032
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA15611
TX
Other
Enumeration date
04/05/2022
Last updated
04/05/2022
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