Healthcare Provider Details

I. General information

NPI: 1497920649
Provider Name (Legal Business Name): MIKELYN CALHOUN RN, BSN,CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2008
Last Update Date: 04/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MEDICAL CENTER DRIVE
PRATTVILLE AL
36066
US

IV. Provider business mailing address

10101 LINN STATION RD SUITE 560
LOUISVILLE KY
40223-3848
US

V. Phone/Fax

Practice location:
  • Phone: 334-361-6380
  • Fax: 334-220-3590
Mailing address:
  • Phone: 502-657-0440
  • Fax: 502-657-0041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number1078255
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: