Healthcare Provider Details

I. General information

NPI: 1982374807
Provider Name (Legal Business Name): ALLISON NICOLE MCMULLEN CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2021
Last Update Date: 10/06/2023
Certification Date: 10/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 HIGHWAY 78 E
JASPER AL
35501-8956
US

IV. Provider business mailing address

3400 HIGHWAY 78 E
JASPER AL
35501-8956
US

V. Phone/Fax

Practice location:
  • Phone: 205-387-4401
  • Fax:
Mailing address:
  • Phone: 205-387-4401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1-178369
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1-178369
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: