MRS. MIRANDA HICKLE


Address: 657 E Broadway Blvd, Suite D, Jefferson City, TN 37760-4948
Phone: 8653756005

MRS. MIRANDA HICKLE (NPI# 1528317054) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1528317054
Entity Type Individual
Full Name MRS. MIRANDA HICKLE
Credential FNP
Practice Address 657 E Broadway Blvd
Suite D
Jefferson City
TN 37760-4948
Practice Telephone 8653756005
Practice Fax Number 8654710244
Mailing Telephone 8653756005
Mailing Fax Number 8654710244
Enumeration Date 2012-08-30
Last Update Date 2014-11-19
Gender Code F
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 363LF0000X Nurse Practitioner
Specialization: Family
16752 TN Physician Assistants & Advanced Practice Nursing Providers

Other Provider Identifier

State Issuer Identifier Type Code
TN 1530430 05

Office Location

Street Address 657 E BROADWAY BLVD
SUITE D
City JEFFERSON CITY
State TN
Zip Code 37760-4948

Providers in the same location

NPI Name Taxonomy Address Enumeration
1639129323 Aqueel M Kouser Internal Medicine 657 E Broadway Blvd, Suite C, Jefferson City, TN 37760-4948 2006-05-11
1073979522 Jeff City Pharmacist Group LLC Dba Md Pharmacy Store 2 Pharmacy 657 E Broadway Blvd, Jefferson City, TN 37760 2016-01-13
1205226032 Healthstar Physicians, PC Internal Medicine 657 E Broadway Blvd, Suite C, Jefferson City, TN 37760-4948 2015-02-02
1487961173 Mountain View Pediatrics and Internal Medicine Clinic/Center 657 E Broadway Blvd, Jefferson City, TN 37760-4948 2010-09-02
1689846271 Patricia Annette Waddell Nurse Practitioner 657 E Broadway Blvd, Suite C, Jefferson City, TN 37760-4948 2008-03-24
1285788323 Steven Todd Sheedlo Emergency Medicine 657 E Broadway Blvd, Ste. C, Jefferson City, TN 37760 2007-01-23
1902820624 Laura Kraus Pediatrics 657 E Broadway Blvd, Suite D, Jefferson City, TN 37760-4948 2006-07-26
1902822588 Optimus Health Center, Inc. Physical Therapist 657 E Broadway Blvd, Jefferson City, TN 37760-4906 2006-07-15
1235178047 Mathew T Kraus Internal Medicine 657 E Broadway Blvd, Suite D, Jefferson City, TN 37760-4948 2006-06-06
1740231646 Debra A Lane Family Medicine 657 E Broadway Blvd, Healthstar Physicians Ste C, Jefferson City, TN 37760 2006-05-15
Find all providers in the same location

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1699235929 Emmley L Cole Nurse Practitioner 277 E W Broadway Blvd, Jefferson, TN 37760 2019-03-22
1275044877 Cindy Anderson Nurse Practitioner 277 E Broadway Blvd, Jefferson City, TN 37760 2017-10-23
1801259940 Mcfarland Group, Inc. Durable Medical Equipment & Medical Supplies 665 E Broadway Blvd, Jefferson City, TN 37760 2016-04-04
1124422266 Penny Williams-cordeiro Nurse Practitioner 1901 Brookside Drive, Suite 105, Kingsport, TN 37760 2014-10-17
1215363841 Lindsey Ann Clyde Physician Assistant 120 Hospital Dr Ste 130, Jefferson City, TN 37760 2013-09-14
1679849814 Allison Renee Farris Surgery 120 Hospital Dr Ste G20, Jefferson City, TN 37760 2012-03-31
1245562891 Steven Jarvis Monroe Dentist 156 W. Broadway Blvd., Jefferson City, TN 37760 2010-02-08
1952560625 Summit Medical Group,pllc Internal Medicine 380 W Broadway Blvd, Jefferson City, TN 37760 2008-06-06
1780756189 Steven J Monroe Dds PC Dentist 156 W Broadway Blvd, Jefferson City, TN 37760 2006-11-14
1720188600 Dennis U Spjut Psychologist 732 E Jefferson St, Dennis Spjut Phd, Jefferson City, TN 37760 2006-09-22
Find all providers in zip 37760

Taxonomy Information

Taxonomy Code 363LF0000X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Nurse Practitioner
Specialization Family

Taxonomy Definition

Definition to come...

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1780211169 Claire Luetkemeyer Nurse Practitioner 213 Michelle Dr, Jefferson City, MO 65109-0135 2020-03-25
1386104818 Renee Jean Scherr Nurse Practitioner 8200 No More Victims Rd, Jefferson City, MO 65101-4539 2019-03-21
1366912362 Julia Ann Babin Nurse Practitioner 1620 Bald Hill Rd, Jefferson City, MO 65101-3804 2018-12-03
1033688924 Sara Marso Nurse Practitioner 2511 W Edgewood Dr Ste D, Jefferson City, MO 65109-5869 2018-11-20
1275044877 Cindy Anderson Nurse Practitioner 277 E Broadway Blvd, Jefferson City, TN 37760 2017-10-23
1871897405 Sarah Elizabeth Hyman Nurse Practitioner 3501a W Truman Blvd, Jefferson City, MO 65109-5715 2010-12-22
1164735221 Kimberly F Shelton Nurse Practitioner 1004 N Highway 92 Ste B, Jefferson City, TN 37760-3687 2010-07-19
1235338252 Sheila Ann Olsen Nurse Practitioner 806 Navajo Dr, Jefferson City, TN 37760-5122 2007-07-11
1225013907 Sharon Mcanear Nurse Practitioner 1646 Russell Ave, Carson-newman College, Jefferson City, TN 37760-2204 2005-12-14
1114909538 Betty Jo Ellington Nurse Practitioner 1413 Russell Ave, Jefferson City, TN 37760-2562 2005-11-20
Find all providers in JEFFERSON CITY

Competitor

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City JEFFERSON CITY
Zip Code 37760

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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