Provider Demographics
NPI:1174099279
Name:MIZELLE, JOHN PAUL (CRNP)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:PAUL
Last Name:MIZELLE
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4534 BLAIRMONT DR SE
Mailing Address - Street 2:
Mailing Address - City:OWENS CROSS ROADS
Mailing Address - State:AL
Mailing Address - Zip Code:35763-8013
Mailing Address - Country:US
Mailing Address - Phone:256-679-7438
Mailing Address - Fax:
Practice Address - Street 1:2017 OBRIG AVE
Practice Address - Street 2:
Practice Address - City:GUNTERSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35976-2156
Practice Address - Country:US
Practice Address - Phone:256-582-2324
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-17
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-089397363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily