| Full Name | |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 35 Willow Ln, Jasper, Alabama |
| Authorized Official Name and Position | Miranda Shae Cody (PMHNP-BC) |
| Authorized Official Contact | 2057176050 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
3608 Highway 78 E Jasper AL 35501-8909 Ph: (205) 717-6050 | 35 Willow Ln Jasper AL 35503-6122 Ph: (205) 717-6050 |
| NPI Number | 1497510028 |
|---|---|
| Provider Enumeration Date | 02/13/2024 |
| Last Update Date | 11/26/2024 |
| Certification Date | 11/26/2024 |
| Medicare PECOS PAC ID | 5092153312 |
|---|---|
| Medicare Enrollment ID | O20240405001854 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497510028 | NPI | - | NPPES |
| Provider Name | Miranda S Handley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083233308 PECOS PAC ID: 0941687354 Enrollment ID: I20220524000924 |
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