MEDICARE: MISS VIVIAN TUCKER REYER CRNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0200X	Pediatric Nurse Practitioner	1105938	AL

General Provider Information

NPI Number	:	1043520901
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS VIVIAN TUCKER REYER CRNP

Provider Business Mailing Address
First Line	:	627 RUMBLE AVE
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35213-1130
Country	:	US
Telephone Number	:	205-746-0203
Fax Number	:

Provider Business Practice Location Address
First Line	:	2001 FIELDSTOWN RD
Second Line	:
City	:	GARDENDALE
State	:	AL
Zip	:	35071-4628
Country	:	US
Telephone Number	:	205-285-2095
Fax Number	:	205-285-2093

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2010
Last Update Date	:	04/06/2026

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