Provider Demographics
NPI:1710463856
Name:MIKELL, LUCY RENA' (MSN, APRN, FNP-C)
Entity type:Individual
Prefix:MRS
First Name:LUCY
Middle Name:RENA'
Last Name:MIKELL
Suffix:
Gender:
Credentials:MSN, APRN, FNP-C
Other - Prefix:MRS
Other - First Name:LUCY
Other - Middle Name:RENA'
Other - Last Name:SIMMONS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP-C
Mailing Address - Street 1:106 POINTE DR
Mailing Address - Street 2:
Mailing Address - City:SUMMIT
Mailing Address - State:MS
Mailing Address - Zip Code:39666-5672
Mailing Address - Country:US
Mailing Address - Phone:601-551-7499
Mailing Address - Fax:
Practice Address - Street 1:721 AVENUE G
Practice Address - Street 2:
Practice Address - City:KENTWOOD
Practice Address - State:LA
Practice Address - Zip Code:70444-2601
Practice Address - Country:US
Practice Address - Phone:225-306-2100
Practice Address - Fax:985-229-5502
Is Sole Proprietor?:No
Enumeration Date:2018-07-12
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS902573363L00000X
LAAP10101363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS08520383Medicaid