Healthcare Provider Details

I. General information

NPI: 1174099279
Provider Name (Legal Business Name): JOHN PAUL MIZELLE CRNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2018
Last Update Date: 10/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2017 OBRIG AVE
GUNTERSVILLE AL
35976-2156
US

IV. Provider business mailing address

4534 BLAIRMONT DR SE
OWENS CROSS ROADS AL
35763-8013
US

V. Phone/Fax

Practice location:
  • Phone: 256-582-2324
  • Fax:
Mailing address:
  • Phone: 256-679-7438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-089397
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: