Brooke Ana Mickavicz, MS, RDN, LDN

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

DN008601 Issued in PA

Practice address

530 S Main St
Taylor, PA 18517-1822

Phone

(570) 702-7729

NPI assigned

Oct 29, 2024

Last updated

Oct 29, 2024By the provider in NPPES

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

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Geisinger Clinic

  • Family Medicine Physician
  • Danville, PA
  • NPI 1366493868
  Medicare reassignment NPD
• Geisinger-HM Joint Venture, LLC

  dba Geisinger Medical Clinic Lock Haven

  • Family Medicine Physician
  • Lock Haven, PA
  • NPI 1144876137
  Medicare reassignment NPD
• Geieinger Clinic

  • Pediatrics Physician
  • Lewisburg, PA
  • NPI 1861916496
  NPD
• Geisinger Clinic

  • Diagnostic Radiology Physician
  • Danville, PA
  • NPI 1558313023
  NPD
• Geisinger-HM Joint Venture, LLC

  • Family Medicine Physician
  • Williamsport, PA
  • NPI 1073075909
  NPD
• Geisinger-HM Joint Venture, LLC

  dba GMG Lycoming Family Practice

  • Family Medicine Physician
  • Montoursville, PA
  • NPI 1740836808
  NPD

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

{
    "created_epoch": "1730160000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730160000000",
    "number": "1861214082",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "530 S MAIN ST",
            "city": "TAYLOR",
            "state": "PA",
            "postal_code": "185171822",
            "telephone_number": "570-702-7729"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "530 S MAIN ST",
            "city": "TAYLOR",
            "state": "PA",
            "postal_code": "185171822",
            "telephone_number": "570-702-7729"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MICKAVICZ",
        "first_name": "BROOKE",
        "middle_name": "ANA",
        "credential": "MS, RDN, LDN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-10-29",
        "last_updated": "2024-10-29",
        "certification_date": "2024-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "PA",
            "license": "DN008601",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kimberly Ann Krisiak
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• Katlyn Marie Lytle Rushing, PA-C
• Ken John Matsko Jr., MS BSL
• Nallin Chiropractic PC
• Nepa Care, LLC.
• Stephen Earl Page, PT
• Lynn Francine Pahoski, MA, CCC-SLP
• Platinum Health at Riverside LLC (Riverside Rehabilitation and Nursing Center)

• Registered Dietitian in Taylor, PA
• Providers in Taylor, PA by specialty
• Registered Dietitian in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.