Provider Demographics
NPI:1427698224
Name:DUCKETT, MICHELE (AGNP)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:DUCKETT
Suffix:
Gender:F
Credentials:AGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19550 E 39TH ST S
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64057-2358
Mailing Address - Country:US
Mailing Address - Phone:913-222-9779
Mailing Address - Fax:
Practice Address - Street 1:19550 E 39TH ST S STE 220
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64057-2305
Practice Address - Country:US
Practice Address - Phone:816-461-6837
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-09
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007005141163WG0000X
KS14-120092-122163WG0000X
KS53-81698-122363LG0600X
MO2020002094363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice