Provider Demographics
NPI:1730415712
Name:MISTLER, CAROL JEAN (ANP-BC)
Entity type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:JEAN
Last Name:MISTLER
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:JEAN
Other - Last Name:THORNTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:101 AZELEA LANE
Mailing Address - Street 2:
Mailing Address - City:REIDSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30453
Mailing Address - Country:US
Mailing Address - Phone:912-515-8300
Mailing Address - Fax:
Practice Address - Street 1:28 LAKE HERON CT W
Practice Address - Street 2:
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322-4040
Practice Address - Country:US
Practice Address - Phone:912-450-4511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-26
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN153038 NP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health