Provider Demographics
NPI:1497787840
Name:ELKINS, MABLE JEANNETTE (ARNP)
Entity Type:Individual
Prefix:MS
First Name:MABLE
Middle Name:JEANNETTE
Last Name:ELKINS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:MABLE
Other - Middle Name:JEANNETTE
Other - Last Name:ELKINS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ARNP
Mailing Address - Street 1:PO BOX 850489
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36685-0489
Mailing Address - Country:US
Mailing Address - Phone:251-342-3949
Mailing Address - Fax:251-631-3361
Practice Address - Street 1:5100 RANGELINE ROAD N
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36619-9504
Practice Address - Country:US
Practice Address - Phone:251-661-4454
Practice Address - Fax:251-661-9843
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3111422363L00000X
AL1-043339363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL306270800Medicaid
AL130030Medicaid
AL511-12684OtherBLUE CROSS OF AL
AL102I509872Medicare PIN
FLY051VZMedicare PIN
AL130030Medicaid
AL511-12684OtherBLUE CROSS OF AL