Healthcare Provider Details

I. General information

NPI: 1639981657
Provider Name (Legal Business Name): MELISSA JOLENE HULL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2025
Last Update Date: 01/25/2025
Certification Date: 01/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 HIGHWAY 78 E
JASPER AL
35501-8956
US

IV. Provider business mailing address

10158 HIGHWAY 124
CARBON HILL AL
35549-5932
US

V. Phone/Fax

Practice location:
  • Phone: 833-251-9899
  • Fax:
Mailing address:
  • Phone: 205-878-5771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1-184000
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: