Audrea H Missildine, CRNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

1-065276 Issued in AL

Practice address

1031 County Road 114
Jack, AL 36346-6264

Phone

(334) 853-0177

Fax

(334) 853-0178

NPI assigned

Aug 11, 2010

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Registered Nurse

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Marathon Health LLC

  • Nurse Practitioner
  • Jack, AL
  • NPI 1700419686
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1281484800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1562889600000",
    "number": "1083929376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1031 COUNTY ROAD 114",
            "city": "JACK",
            "state": "AL",
            "postal_code": "363466264",
            "telephone_number": "334-853-0177",
            "fax_number": "334-853-0178"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1031 COUNTY ROAD 114",
            "city": "JACK",
            "state": "AL",
            "postal_code": "363466264",
            "telephone_number": "334-853-0177",
            "fax_number": "334-853-0178"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MISSILDINE",
        "first_name": "AUDREA",
        "middle_name": "H",
        "name_prefix": "Mrs.",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-08-11",
        "last_updated": "2019-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AL",
            "license": "1-065276",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marathon Health LLC
• Samantha Jean McCollough, CRNP

• Family Nurse Practitioner in Jack, AL
• Providers in Jack, AL by specialty
• Family Nurse Practitioner in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.