Healthcare Provider Details

I. General information

NPI: 1023876653
Provider Name (Legal Business Name): MAGAN RENEA OWENS CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2024
Last Update Date: 03/08/2024
Certification Date: 03/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 SMITH RD
ALBERTVILLE AL
35951-3412
US

IV. Provider business mailing address

PO BOX 1397
ALBERTVILLE AL
35950-0023
US

V. Phone/Fax

Practice location:
  • Phone: 256-891-1460
  • Fax: 256-891-2640
Mailing address:
  • Phone: 256-891-1460
  • Fax: 256-891-2640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-164369
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: