Provider Demographics
NPI:1427716331
Name:FREEHAN, MICAYLA KATHLEEN (NP)
Entity type:Individual
Prefix:
First Name:MICAYLA
Middle Name:KATHLEEN
Last Name:FREEHAN
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 1:1009 DAWSON ST
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76704-1913
Mailing Address - Country:US
Mailing Address - Phone:508-523-7695
Mailing Address - Fax:
Practice Address - Street 1:1009 DAWSON ST
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76704-1913
Practice Address - Country:US
Practice Address - Phone:508-523-7695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-08
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1026164163W00000X, 163WP0200X, 363LP0200X
CA95221700163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered Nurse
No163WP0200XNursing Service ProvidersRegistered NursePediatrics