Healthcare Provider Details

I. General information

NPI: 1619434818
Provider Name (Legal Business Name): CALLIE GRACE CICHRA FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2019
Last Update Date: 12/07/2021
Certification Date: 09/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1022 1ST ST N
ALABASTER AL
35007-8706
US

IV. Provider business mailing address

1022 1ST ST N
ALABASTER AL
35007-8706
US

V. Phone/Fax

Practice location:
  • Phone: 205-663-5775
  • Fax:
Mailing address:
  • Phone: 205-663-5775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-141242
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: