Healthcare Provider Details

I. General information

NPI: 1710651286
Provider Name (Legal Business Name): CORIE MITCHELL CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2021
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 BAY ST
GADSDEN AL
35901-5179
US

IV. Provider business mailing address

501 BAY ST
GADSDEN AL
35901-5179
US

V. Phone/Fax

Practice location:
  • Phone: 256-543-2894
  • Fax:
Mailing address:
  • Phone: 256-543-2894
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number1184302
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: