MEDICARE: TABITHA MCMULLIN FLETCHER 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	363LG0600X	Gerontology Nurse Practitioner	1-143204	AL

General Provider Information

NPI Number	:	1780128421
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TABITHA MCMULLIN FLETCHER CRNP

Provider Business Mailing Address
First Line	:	PO BOX 55310
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35255-5310
Country	:	US
Telephone Number	:	205-731-9701
Fax Number	:	205-297-9411

Provider Business Practice Location Address
First Line	:	2321 JOHN HAWKINS PKWY
Second Line	:
City	:	HOOVER
State	:	AL
Zip	:	35244-3540
Country	:	US
Telephone Number	:	205-989-7254
Fax Number	:

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

Provider Enumeration Date	:	12/15/2016
Last Update Date	:	02/27/2026

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