Healthcare Provider Details

I. General information

NPI: 1124591177
Provider Name (Legal Business Name): MELISSA ANDERSON MAYFIELD CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2019
Last Update Date: 01/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15239 AL HIGHWAY 68 STE B
CROSSVILLE AL
35962-3481
US

IV. Provider business mailing address

15239 AL HIGHWAY 68 STE B
CROSSVILLE AL
35962-3481
US

V. Phone/Fax

Practice location:
  • Phone: 256-925-0012
  • Fax: 256-925-0016
Mailing address:
  • Phone: 256-925-0012
  • Fax: 256-925-0016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-118446
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: