Provider Demographics
NPI:1710923271
Name:MIDGETTE, JOEL A SR (CRNA)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:A
Last Name:MIDGETTE
Suffix:SR
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6701 AIRPORT BLVD
Mailing Address - Street 2:SUITE D430B
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-6705
Mailing Address - Country:US
Mailing Address - Phone:251-631-3270
Mailing Address - Fax:251-631-3273
Practice Address - Street 1:6701 AIRPORT BLVD
Practice Address - Street 2:SUITE D430B
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-6705
Practice Address - Country:US
Practice Address - Phone:251-631-3270
Practice Address - Fax:251-631-3273
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK134236367500000X
AL1-039206367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09076891Medicaid
AL051552004Medicaid
AL51509784OtherBCBS
MS09076891Medicaid
AL051552004Medicare PIN
AL430074805Medicare PIN