Healthcare Provider Details

I. General information

NPI: 1023854445
Provider Name (Legal Business Name): KIRBY S SEWELL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/04/2024
Last Update Date: 07/07/2024
Certification Date: 07/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 S THREE NOTCH ST
ANDALUSIA AL
36420-3710
US

IV. Provider business mailing address

501 SANFORD RD
ANDALUSIA AL
36420-4123
US

V. Phone/Fax

Practice location:
  • Phone: 334-343-6129
  • Fax:
Mailing address:
  • Phone: 606-344-7997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1-160175
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: