Jovanna Rose Mickie, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

0110002468 Issued in VA

Practice address

1001 Sam Perry
Fredericksburg, VA 22408-1822

Phone

(540) 741-1167

NPI assigned

May 16, 2009

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in VA

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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.

• Fredericksburg Emergency Medical Alliance, Inc.

  • Emergency Medicine Physician
  • Fredericksburg, VA
  • NPI 1396779153
  Medicare reassignment

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

{
    "created_epoch": "1242432000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1352332800000",
    "number": "1790910008",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 SAM PERRY",
            "city": "FREDERICKSBURG",
            "state": "VA",
            "postal_code": "224081822",
            "telephone_number": "540-741-1167"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 SAM PERRY",
            "city": "FREDERICKSBURG",
            "state": "VA",
            "postal_code": "224081822",
            "telephone_number": "540-741-1167"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MICKIE",
        "first_name": "JOVANNA",
        "middle_name": "ROSE",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-05-16",
        "last_updated": "2012-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "VA",
            "license": "0110002468",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0110002468",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michael Morch D.D.S. P.C.
• Katherine Michael, MD, MHS, IBCLC
• Cara Michaels Palmer
• Michelle Sjolinder, PLLC (Michelle Sjolinder, PsyD)
• Bradley John Michielson, MD
• Meredith L. Migliaccio, MSW
• Louis Mihota, OTR
• Makeda Sahlu Mikael, RDN
• Samantha Mikelson
• Yaswitha Mikkilineni

• Medical Physician Assistant in Fredericksburg, VA
• Providers in Fredericksburg, VA by specialty
• Medical Physician Assistant in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2012; 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.