Kathleen Patricia Mickow, FNP-BC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

209.008533 Issued in IL

Practice address

1942 Dempster St
Evanston, IL 60202-1016

Phone

(847) 869-6315

NPI assigned

Dec 13, 2010

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

Not listed in the public Medicare enrollment file

Eligible to order & refer

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

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1292198400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571961600000",
    "number": "1245533264",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 SHEFFIELD LN",
            "city": "VERNON HILLS",
            "state": "IL",
            "postal_code": "600612929",
            "telephone_number": "630-857-6014"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1942 DEMPSTER ST",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602021016",
            "telephone_number": "847-869-6315"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MICKOW",
        "first_name": "KATHLEEN",
        "middle_name": "PATRICIA",
        "name_prefix": "Ms.",
        "credential": "FNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-12-13",
        "last_updated": "2019-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209.008533",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Zachary David Michalicek, D.O.
• Michelle Ferris, LCSW, PLLC
• Margaret Gross Michelson, M.D.
• Lisa Marie Michener, PHARM.D., M.S.
• Amanda Micklo, DO
• Midwest Allied Pathologists LLC
• Midwest Center for Women'S Healthcare
• Midwest Center for Women'S Healthcare
• Mie Tamura
• Mie Tamura Counseling LLC

• Family Nurse Practitioner in Evanston, IL
• Providers in Evanston, IL by specialty
• Family Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2019; 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.