Provider Demographics
NPI:1376968495
Name:PRATT, MICHELLE RENEE (CRNP)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:RENEE
Last Name:PRATT
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:RENEE
Other - Last Name:MCCLELLAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1210 GRANDEVIEW BLVD APT 3011
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35824-2430
Mailing Address - Country:US
Mailing Address - Phone:256-656-8263
Mailing Address - Fax:
Practice Address - Street 1:708 WILL HALSEY WAY STE C
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-2566
Practice Address - Country:US
Practice Address - Phone:256-325-1349
Practice Address - Fax:256-325-1354
Is Sole Proprietor?:No
Enumeration Date:2014-02-26
Last Update Date:2022-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-053076363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL330000025Medicaid