| Name: | Mizell Healthcare, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Limited Liability Company |
| Status: | Exists |
| Date of registration: | 12 Aug 2022 (2 years ago) (Companies founded in August 2022) |
| Entity Number: | 001-034-559 |
| Register Number: | 001034559 |
| ZIP code: | 36541 (Companies in Mobile, 36541) |
| County: | Mobile |
| Place of Formation: | Alabama |
| Registered Office Street Address: | 10750 Union CourtGrand Bay, AL 36541 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1083339121 | 2022-10-11 | 2023-02-14 | PO BOX 787, GRAND BAY, AL, 365410787, US | 1962 SPRING HILL AVE, MOBILE, AL, 366072304, US | |||||||||||||||||||||||||
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| Phone | +1 251-802-3595 |
| Fax | 2288967174 |
Authorized person
| Name | MRS. BABETTE JACKSON |
| Role | ADMINISTRATOR |
| Phone | 2518023595 |
Taxonomy
| Taxonomy Code | 363L00000X - Nurse Practitioner |
| Is Primary | Yes |
| Taxonomy Code | 363LF0000X - Family Nurse Practitioner |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 293842 |
| State | AL |
| Name | Role |
|---|---|
| Mizell, Amanda R Mizell | Agent |
Date of last update: 17 Aug 2024
Sources: Alabama Secretary of State
