Healthcare Provider Details

I. General information

NPI: 1336031327
Provider Name (Legal Business Name): CLARENCE MIZELL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2025
Last Update Date: 07/16/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

281 MAPLE AVE
OAK HILL WV
25901-3475
US

IV. Provider business mailing address

2101 S KANAWHA ST
BECKLEY WV
25801-6717
US

V. Phone/Fax

Practice location:
  • Phone: 304-465-3302
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: