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General NPI Number Information
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NPI Number | 1932071669
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Entity Type | Individual
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Provider Name | MOLLY MICHELLE CISSELL PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/22/2025
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Last Update Date | 09/22/2025
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Provider Practice Location Address
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Address Line | 1373 E STATE ROAD 62
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City | MADISON
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State | IN
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Zip | 47250-7328
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Country | US
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Telephone | 812-820-1433
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Fax |
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Provider Business Mailing Address
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Address Line | 15007 SILVER PLAINS TRCE
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City | MEMPHIS
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State | IN
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Zip | 47143-9276
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Country | US
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Telephone | 812-820-1433
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State | IN
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