Active NPI
Dennis Lynn Mickleson, M.D.
- Adult Medicine Physician
- Palmer, AK
National Provider Identifier
1619388600
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Adult Medicine Physician
- License
- AA2638
- Practice address
- 8220 Gold Bullion Blvd
Palmer, AK 99645 - Phone
- (907) 745-0832
- Fax
- (907) 745-0832
- NPI assigned
- May 13, 2014
- Last updated
- May 13, 2014
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Medicine Physician | 207QA0505X | AA2638 | AK | Primary |
Addresses
Primary practice location
8220 Gold Bullion Blvd
Palmer, AK 99645
Mailing address
PO Box 2863
Palmer, AK 99645-2863
Phone (907) 745-0832
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AA2638 | AK | MD | Adult Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1399939200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1399939200000",
"number": "1619388600",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2863",
"city": "PALMER",
"state": "AK",
"postal_code": "996452863",
"telephone_number": "907-745-0832",
"fax_number": "907-745-0832"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8220 GOLD BULLION BLVD",
"city": "PALMER",
"state": "AK",
"postal_code": "99645",
"telephone_number": "907-745-0832",
"fax_number": "907-745-0832"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MICKLESON",
"first_name": "DENNIS",
"middle_name": "LYNN",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-05-13",
"last_updated": "2014-05-13",
"status": "A"
},
"taxonomies": [
{
"code": "207QA0505X",
"taxonomy_group": "",
"desc": "Family Medicine, Adult Medicine",
"state": "AK",
"license": "AA2638",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Palmer, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.