Provider Demographics
NPI:1801697289
Name:MUMPHREY JOHNSON, ANDREA (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:MUMPHREY JOHNSON
Suffix:
Gender:
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3552 PELHAM PKWY # 1096
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35124-2012
Mailing Address - Country:US
Mailing Address - Phone:205-419-9980
Mailing Address - Fax:
Practice Address - Street 1:3552 PELHAM PKWY # 1096
Practice Address - Street 2:
Practice Address - City:PELHAM
Practice Address - State:AL
Practice Address - Zip Code:35124-2012
Practice Address - Country:US
Practice Address - Phone:205-419-9980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-21
Last Update Date:2025-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2024065338363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health