Provider Demographics
NPI:1477335891
Name:MIKELL, MARLA KRISTEN (FNP-C)
Entity Type:Individual
Prefix:
First Name:MARLA
Middle Name:KRISTEN
Last Name:MIKELL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:MARLA
Other - Middle Name:KRISTEN
Other - Last Name:MIKELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:956 BURNELL GASKINS RD
Mailing Address - Street 2:
Mailing Address - City:WILLACOOCHEE
Mailing Address - State:GA
Mailing Address - Zip Code:31650-6136
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:101 HARRIS INDUSTRIAL BLVD STE A
Practice Address - Street 2:
Practice Address - City:VIDALIA
Practice Address - State:GA
Practice Address - Zip Code:30474-8852
Practice Address - Country:US
Practice Address - Phone:912-535-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-19
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN275033363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner