Provider Demographics
NPI:1306396676
Name:CAGLE, MITCHELL RYAN (NP-C)
Entity Type:Individual
Prefix:MR
First Name:MITCHELL
Middle Name:RYAN
Last Name:CAGLE
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4427 OXFORD GATE DR
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35405-4768
Mailing Address - Country:US
Mailing Address - Phone:205-294-1819
Mailing Address - Fax:
Practice Address - Street 1:100 TOWNCENTER BLVD
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35406-1833
Practice Address - Country:US
Practice Address - Phone:205-462-3334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-10
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-124207363LF0000X
ALF08161087363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily