Provider Demographics
NPI:1205129715
Name:MCCULLOUGH, JAMES RAYMOND (FNP)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:RAYMOND
Last Name:MCCULLOUGH
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8595 N LAMHATTY LN
Mailing Address - Street 2:
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-6481
Mailing Address - Country:US
Mailing Address - Phone:251-744-9058
Mailing Address - Fax:
Practice Address - Street 1:2050 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36615-1113
Practice Address - Country:US
Practice Address - Phone:251-434-6770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-17
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL136894363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily