Provider Demographics
NPI:1619797438
Name:PURNELL, MYESHIA
Entity type:Individual
Prefix:
First Name:MYESHIA
Middle Name:
Last Name:PURNELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 SMITHERMAN SUB
Mailing Address - Street 2:
Mailing Address - City:MONTEVALLO
Mailing Address - State:AL
Mailing Address - Zip Code:35115-1108
Mailing Address - Country:US
Mailing Address - Phone:770-548-9700
Mailing Address - Fax:
Practice Address - Street 1:24 SMITHERMAN SUB
Practice Address - Street 2:
Practice Address - City:MONTEVALLO
Practice Address - State:AL
Practice Address - Zip Code:35115-1108
Practice Address - Country:US
Practice Address - Phone:770-548-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-15
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL171400000X, 3747A0650X, 3747P1801X, 376J00000X, 374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No171400000XOther Service ProvidersHealth & Wellness Coach
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No376J00000XNursing Service Related ProvidersHomemaker