Active NPI
Amanda Renia Mizell, CRNP
- Family Nurse Practitioner
- Gulfport, MS
National Provider Identifier
1679896575
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- R880871
- Practice address
- 1212 E Pass Rd
Gulfport, MS 39507-3403 - Phone
- (228) 896-7108
- Fax
- (228) 896-7174
- NPI assigned
- Mar 5, 2010
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 1-111977 | AL | |
| Family Nurse Practitioner | 363LF0000X | R880871 | MS | Primary |
Addresses
Primary practice location
1212 E Pass Rd
Gulfport, MS 39507-3403
Mailing address
PO Box 787
Grand Bay, AL 36541-0787
Phone (228) 896-7108
Other practice location 1
12303 Highway 49
Gulfport, MS 39503
Phone (228) 206-6882
Other practice location 2
1962 Spring Hill Ave
Mobile, AL 36607
Phone (251) 802-3595
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MS, AL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 2
Care Compare profile
Medicare Care Compare- Specialty
- Nurse Practitioner
- Education
- Other, 2009
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1212 E Pass Rd
Gulfport, MS 39507-3403
Phone (228) 896-7108
12303 Hwy 49
Gulfport, MS 39503-2780
Phone (228) 896-7108
Hospital & facility affiliations
- Singing River Gulfport
- Memorial Hospital Biloxi
- Memorial Hospital at Gulfport
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1-111977 | AL | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mizell Healthcare LLC | Nurse Practitioner | Current | Accepting new patients |
| Southern Family Urgent Care LLC | Nurse Practitioner | Current | Accepting new patients |
| A R Mizell LLC | Family | Current | Accepting new patients |
| Urgent Care of Long Beach LLC | Past | Accepting new patients |
Locations
1962 Spring Hill Ave
Mobile, AL 36607
Phone (251) 471-5701
1212 E Pass Rd
Gulfport, MS 39507
Phone (228) 896-7108
12303 Highway 49
Gulfport, MS 39503
Phone (228) 832-6221
Organizations & group practices 4
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.
-
- Family Nurse Practitioner
- Gulfport, MS
- NPI 1144582040
-
- Urgent Care Clinic/Center
- Gulfport, MS
- NPI 1396379186
Nurse Practitioner
-
- Nurse Practitioner
- Mobile, AL
- NPI 1083339121
-
- Family Medicine Physician
- Long Beach, MS
- NPI 1750592036
Hospital & facility affiliations 61
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Gulfport, MS
- NPI 1073606901
-
- Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
- Gulfport, MS
- NPI 1184956815
Hospital
-
- General Acute Care Hospital
- Biloxi, MS
- NPI 1215546635
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1267747200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1676332800000",
"number": "1679896575",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 787",
"city": "GRAND BAY",
"state": "AL",
"postal_code": "365410787",
"telephone_number": "228-896-7108",
"fax_number": "228-896-7174"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1212 E PASS RD",
"city": "GULFPORT",
"state": "MS",
"postal_code": "395073403",
"telephone_number": "228-896-7108",
"fax_number": "228-896-7174"
}
],
"practiceLocations": [
{
"address_1": "12303 Highway 49",
"address_purpose": "LOCATION",
"city": "Gulfport",
"state": "MS",
"postal_code": "39503",
"country_code": "US",
"telephone_number": "228-206-6882",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1962 Spring Hill Ave",
"address_purpose": "LOCATION",
"city": "Mobile",
"state": "AL",
"postal_code": "36607",
"country_code": "US",
"telephone_number": "251-802-3595",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MIZELL",
"first_name": "AMANDA",
"middle_name": "RENIA",
"name_prefix": "Mrs.",
"credential": "CRNP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-03-05",
"last_updated": "2023-02-14",
"certification_date": "2023-02-14",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "AL",
"license": "1-111977",
"primary": false
},
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "MS",
"license": "R880871",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gulfport, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2023; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.