Jarlisa Mickey, RN, A-GPCNP-C

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

220528 Issued in AR

Practice address

10175 Little Patuxent Pkwy
Columbia, MD 21044-2655

Phone

(501) 553-1153

NPI assigned

Aug 19, 2022

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner, Registered Nurse

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Curana Health of Arkansas LLC

  • Nurse Practitioner
  • Bentonville, AR
  • NPI 1659750214
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1660867200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724630400000",
    "number": "1093433641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10175 LITTLE PATUXENT PKWY",
            "city": "COLUMBIA",
            "state": "MD",
            "postal_code": "210442655"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10175 LITTLE PATUXENT PKWY",
            "city": "COLUMBIA",
            "state": "MD",
            "postal_code": "210442655",
            "telephone_number": "501-553-1153"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MICKEY",
        "first_name": "JARLISA",
        "credential": "RN, A-GPCNP-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-08-19",
        "last_updated": "2024-08-26",
        "certification_date": "2024-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "AR",
            "license": "220528",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mariah Anne Miano, PT
• Tony Miaoudou
• Michael I Muul DDS PA
• Michael S. Lasser M.D. P.a.
• Patrick Durfee Michael, MD
• Weronika Anna Micula-Gondek, M.D.
• Mid-Atlantic Nephrology Associates PA
• Mid-Atlantic Neurology Consultants
• Midatlantic Center for Digestive and Liver Disorders, LLC
• June Lynn Middaugh, CRNA

• Gerontology Nurse Practitioner in Columbia, MD
• Providers in Columbia, MD by specialty
• Gerontology Nurse Practitioner in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.