Healthcare Provider Details

I. General information

NPI: 1952956021
Provider Name (Legal Business Name): PATRICIA NELSON ALC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2019
Last Update Date: 08/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1307 CHRISTINE AVE
ANNISTON AL
36207-4661
US

IV. Provider business mailing address

322 IRBY DR
EASTABOGA AL
36260-5531
US

V. Phone/Fax

Practice location:
  • Phone: 256-235-3799
  • Fax:
Mailing address:
  • Phone: 256-591-2748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberC3184A
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: