Provider Demographics
NPI:1083233308
Name:CODY, MIRANDA SHAE (PMHNP-BC)
Entity type:Individual
Prefix:MS
First Name:MIRANDA
Middle Name:SHAE
Last Name:CODY
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:MS
Other - First Name:MIRANDA
Other - Middle Name:SHAE
Other - Last Name:HANDLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PMHNP-BC
Mailing Address - Street 1:35 WILLOW LN
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:AL
Mailing Address - Zip Code:35503-6122
Mailing Address - Country:US
Mailing Address - Phone:205-717-6050
Mailing Address - Fax:205-892-9272
Practice Address - Street 1:35 WILLOW LN
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35503-6122
Practice Address - Country:US
Practice Address - Phone:205-717-6050
Practice Address - Fax:205-892-9272
Is Sole Proprietor?:No
Enumeration Date:2020-04-16
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-156251363LP0808X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse