Individual provider Active NPI

Jessica Nichole Mickels, RNFA

  • Adult Health Nurse Practitioner
  • Hannibal, MO
National Provider Identifier
1164066023
Registry record updated Nov 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
2023040437 Issued in MO
Practice address
6000 Hospital Dr
Hannibal, MO 63401-6887
Phone
(573) 248-5115
Fax
(573) 248-5196
NPI assigned
Nov 4, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 6, 2023

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X 2023040437 MO
Registered Nurse First Assistant 163WR0006X 2013025149 MO
Gerontology Nurse Practitioner 363LG0600X 2023040437 MO
Adult Health Nurse Practitioner 363LA2200X 2023040437 MO Primary

Addresses

Primary practice location

6000 Hospital Dr
Hannibal, MO 63401-6887

Mailing address

PO Box 551
Hannibal, MO 63401-0551
Phone (573) 248-5115

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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

Enrollment IDStateProvider typePAC IDDetails
I20231111000397 MO Practitioner - Nurse Practitioner 1153778261 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

6500 Hospital Dr
Hannibal, MO 63401-6890
Phone (573) 248-1300

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
2013025149MOMDRegistered Nurse First Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Hannibal Regional Healthcare System, Inc CurrentSince Oct 23, 2023 Accepting new patients
Hannibal Regional Healthcare System Inc CurrentSince Oct 23, 2023 Accepting new patients
Hannibal Regional Healthcare System, Inc Past Accepting new patients

Locations

6000 Hospital Dr
Hannibal, MO 63401
Phone (573) 248-5460

6500 Hospital Dr
Hannibal, MO 63401
Phone (573) 629-3400

Interoperability endpoints

  • FHIR API: https://fhir.fhirpoint.open.allscripts.com/fhirroute/open/10040602
  • Direct secure messaging: jessicamickels@hrmg.allscriptsdirect.net

Organizations & group practices 3

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.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1572825600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699228800000",
    "number": "1164066023",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 551",
            "city": "HANNIBAL",
            "state": "MO",
            "postal_code": "634010551",
            "telephone_number": "573-248-5115",
            "fax_number": "573-248-5196"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6000 HOSPITAL DR",
            "city": "HANNIBAL",
            "state": "MO",
            "postal_code": "634016887",
            "telephone_number": "573-248-5115",
            "fax_number": "573-248-5196"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MICKELS",
        "first_name": "JESSICA",
        "middle_name": "NICHOLE",
        "credential": "RNFA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-11-04",
        "last_updated": "2023-11-06",
        "certification_date": "2023-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "MO",
            "license": "2023040437",
            "primary": false
        },
        {
            "code": "163WR0006X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Registered Nurse First Assistant",
            "state": "MO",
            "license": "2013025149",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "MO",
            "license": "2023040437",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "MO",
            "license": "2023040437",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hannibal, MO

Sources for this page

Verify at the official NPI Registry.