Provider Demographics
NPI:1831537497
Name:JOHNSON, MARCHELE LYNETTE (NP)
Entity type:Individual
Prefix:
First Name:MARCHELE
Middle Name:LYNETTE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 S UNIVERSITY BLVD BLDG 1
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36609-7859
Mailing Address - Country:US
Mailing Address - Phone:251-633-5155
Mailing Address - Fax:251-633-5125
Practice Address - Street 1:820 S UNIVERSITY BLVD BLDG 1
Practice Address - Street 2:SUITE 1B
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36609-7859
Practice Address - Country:US
Practice Address - Phone:251-633-5155
Practice Address - Fax:251-633-5125
Is Sole Proprietor?:No
Enumeration Date:2013-06-05
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-123856363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL511-70526OtherBCBS OF AL
AL102I565053Medicare PIN