Active NPI
Kathleen Dekoven McMicken, ARNP
- Nurse Practitioner
- Bartow, FL
National Provider Identifier
1689646317
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- ARNP528982
- Practice address
- 2250 Osprey Blvd
Ste 100
Bartow, FL 33830 - Phone
- (863) 533-7151
- Fax
- (863) 533-7214
- NPI assigned
- Feb 6, 2006
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | ARNP528982 | FL | Primary |
Addresses
Primary practice location
2250 Osprey Blvd
Ste 100
Bartow, FL 33830
Mailing address
PO Box 95004
Lakeland, FL 33804
Phone (863) 680-7206
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)
- Enrolled
- Credentials
- Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Watson Clinic LLP | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Clinical Medical Laboratory
- Lakeland, FL
- NPI 1558409730
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1139184000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1193788800000",
"number": "1689646317",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 95004",
"city": "LAKELAND",
"state": "FL",
"postal_code": "33804",
"telephone_number": "863-680-7206",
"fax_number": "863-680-7420"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2250 OSPREY BLVD",
"address_2": "STE 100",
"city": "BARTOW",
"state": "FL",
"postal_code": "33830",
"telephone_number": "863-533-7151",
"fax_number": "863-533-7214"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCMICKEN",
"first_name": "KATHLEEN",
"middle_name": "DEKOVEN",
"credential": "ARNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-02-06",
"last_updated": "2007-10-31",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "FL",
"license": "ARNP528982",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bartow, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.