Healthcare Provider Details

I. General information

NPI: 1992082069
Provider Name (Legal Business Name): EVELYN RYCE NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2011
Last Update Date: 05/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23989 AL HIGHWAY 55
ANDALUSIA AL
36420-5470
US

IV. Provider business mailing address

201 MONROE STREET. SUITE 1386 ADPH BUREAU OF FAMILY HEALTH SERVICES
MONTGOMERY AL
36104-2815
US

V. Phone/Fax

Practice location:
  • Phone: 334-427-2800
  • Fax:
Mailing address:
  • Phone: 334-206-7959
  • Fax: 334-206-3998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1-118834
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: