Basic Information
| Provider Information | |||||||||
| NPI: | 1760631410 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | POCKER | ||||||||
| FirstName: | MICKI | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 776351 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606776351 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5022725395 | ||||||||
| FaxNumber: | 5022725339 | ||||||||
| Practice Location | |||||||||
| Address1: | 601 S FLOYD ST STE 300 | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402021837 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5026291515 | ||||||||
| FaxNumber: | 5026291545 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/17/2008 | ||||||||
| LastUpdateDate: | 09/17/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LW0102X | 3005612 | KY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health |
ID Information
| ID | Type | State | Issuer | Description | 105635 | 01 | KY | SIHO - LMVA | OTHER | 000023036V | 01 | KY | HUMANA - LMVA | OTHER | P00828506 | 01 | KY | RAILROAD MEDICARE - LMVA | OTHER | 7100072010 | 05 | KY | MEDICAID | 50024344 | 01 | KY | PASSPORT - LMVA | OTHER | 000000735276 | 01 | KY | ANTHEM - WOMEN'S SPECIALIST | OTHER | 1408744 | 01 | KY | CIGNA - LMVA | OTHER | 3721649000 | 01 | KY | PASSPORT ADVANTAGE - LMVA | OTHER | 000000620804 | 01 | KY | ANTHEM - LMVA | OTHER | 200947930 | 05 | IN | MEDICAID |