Provider Demographics
NPI:1053953794
Name:NORMAN, MICA LADON (NP)
Entity type:Individual
Prefix:
First Name:MICA
Middle Name:LADON
Last Name:NORMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 WILSON ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:TX
Mailing Address - Zip Code:75652-5956
Mailing Address - Country:US
Mailing Address - Phone:903-655-6536
Mailing Address - Fax:903-509-5835
Practice Address - Street 1:300 WILSON ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:TX
Practice Address - Zip Code:75652-5956
Practice Address - Country:US
Practice Address - Phone:903-655-6536
Practice Address - Fax:903-657-6072
Is Sole Proprietor?:No
Enumeration Date:2019-10-15
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP143541363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily