Provider Demographics
NPI:1154446755
Name:MACKLIN, MELLINY M (CRNP)
Entity Type:Individual
Prefix:
First Name:MELLINY
Middle Name:M
Last Name:MACKLIN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4 MISSISSIPPI DR
Mailing Address - Street 2:
Mailing Address - City:PHENIX CITY
Mailing Address - State:AL
Mailing Address - Zip Code:36869-3704
Mailing Address - Country:US
Mailing Address - Phone:334-480-0667
Mailing Address - Fax:334-742-2840
Practice Address - Street 1:2506 LAMBERT DR
Practice Address - Street 2:
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801-7237
Practice Address - Country:US
Practice Address - Phone:334-742-2700
Practice Address - Fax:334-742-2840
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-069183363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner