Provider Demographics
NPI:1114557030
Name:MULLICAN, MELEA LENORE (PA-C)
Entity Type:Individual
Prefix:
First Name:MELEA
Middle Name:LENORE
Last Name:MULLICAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 18428
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35804-8428
Mailing Address - Country:US
Mailing Address - Phone:256-705-4224
Mailing Address - Fax:
Practice Address - Street 1:1107 14TH AVE SE STE 200
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-3354
Practice Address - Country:US
Practice Address - Phone:256-705-4224
Practice Address - Fax:256-705-4135
Is Sole Proprietor?:No
Enumeration Date:2020-01-20
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1585363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant