Provider Demographics
NPI:1619964640
Name:MITCHELL, MELANIE A (NP)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:A
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 870
Mailing Address - Street 2:
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35056-0870
Mailing Address - Country:US
Mailing Address - Phone:256-775-0432
Mailing Address - Fax:256-775-6305
Practice Address - Street 1:1701 MAIN AVE SW
Practice Address - Street 2:SUITE A
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35055-5299
Practice Address - Country:US
Practice Address - Phone:256-737-0880
Practice Address - Fax:256-737-9191
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1043177363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL631058174008OtherTRICARE
ALP00009878OtherMEDICARE RAILROAD
AL631058174OtherUNITED HEALTHCARE
AL891008210Medicaid
AL541003895OtherRURAL HEALTH
AL51520723OtherBLUE CROSS
AL51520723OtherBLUE CROSS
AL631058174OtherUNITED HEALTHCARE