Individual provider Active NPI

Ashlee Diane Mickelson, M.D.

  • Pediatrics Physician
  • Spokane, WA
National Provider Identifier
1104027861
Registry record updated Nov 4, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
MD60458815 Issued in WA
Practice address
3919 N Maple St
Spokane, WA 99205-1349
Phone
(509) 444-8888
Fax
(509) 444-7806
NPI assigned
May 30, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 4, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X MD60458815 WA Primary

Addresses

Primary practice location

3919 N Maple St
Spokane, WA 99205-1349

Mailing address

611 N Iron Bridge Way
Spokane, WA 99202-4932
Phone (509) 444-8888

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140916001694 WA Practitioner - Pediatric Medicine 3870712300 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Community Health Association of Spokane CurrentSince Aug 4, 2014 Accepting new patients
Community Health Association of Spokane Current Accepting new patients
Community Health Association of Spokane CurrentSince Aug 4, 2014 Accepting new patients
Community Health Association of Spokane Past Accepting new patients

Locations

1203 Idaho St
Lewiston, ID 83501
Phone (208) 848-8300

803 S Main St
Ste 120
Moscow, ID 83843
Phone (208) 848-8300

1720 2nd St
Cheney, WA 99004
Phone (207) 865-8002

203 N Washington St
Ste 300
Spokane, WA 99201

3919 N Maple St
Spokane, WA 99205
Phone (509) 326-6900

914 W Carlisle Ave
Spokane, WA 99205
Phone (509) 325-0393

1001 W 2nd Ave
Spokane, WA 99201
Phone (509) 835-1205

5620 S Regal St
Ste 11
Spokane, WA 99223
Phone (509) 340-1590

611 N Iron Bridge Way
Spokane, WA 99202

5901 N Lidgerwood St
Ste 126
Spokane, WA 99208
Phone (509) 434-1990

5921 N Market St
Spokane, WA 99208
Phone (509) 487-1604

1502 N Vercler Rd
Spokane Valley, WA 99216
Phone (509) 444-8204

Interoperability endpoints

  • Direct secure messaging: ashlee.mickelson.1@11411.direct.athenahealth.com

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1180483200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635984000000",
    "number": "1104027861",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "611 N IRON BRIDGE WAY",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992024932",
            "telephone_number": "509-444-8888",
            "fax_number": "509-444-7806"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3919 N MAPLE ST",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992051349",
            "telephone_number": "509-444-8888",
            "fax_number": "509-444-7806"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MICKELSON",
        "first_name": "ASHLEE",
        "middle_name": "DIANE",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-30",
        "last_updated": "2021-11-04",
        "certification_date": "2021-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WA",
            "license": "MD60458815",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Spokane, WA

Sources for this page

Verify at the official NPI Registry.