Healthcare Provider Details

I. General information

NPI: 1639321086
Provider Name (Legal Business Name): AMY BRANYON BIGHAM CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2008
Last Update Date: 10/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 CARROLLTON RD STE B
ALICEVILLE AL
35442-1824
US

IV. Provider business mailing address

1400 CARROLLTON RD STE B
ALICEVILLE AL
35442-1824
US

V. Phone/Fax

Practice location:
  • Phone: 205-373-6323
  • Fax: 205-373-2544
Mailing address:
  • Phone: 205-373-6323
  • Fax: 205-373-2544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-072607
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: