Healthcare Provider Details

I. General information

NPI: 1205886413
Provider Name (Legal Business Name): NEAL D MULKEY CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E 10TH ST
ANNISTON AL
36207-4716
US

IV. Provider business mailing address

PO BOX 10484
BIRMINGHAM AL
35202-0484
US

V. Phone/Fax

Practice location:
  • Phone: 256-235-5860
  • Fax:
Mailing address:
  • Phone: 205-322-1808
  • Fax: 205-322-1851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1-074370
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: