Healthcare Provider Details

I. General information

NPI: 1346801347
Provider Name (Legal Business Name): MATTHEW BARNETT CRNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2019
Last Update Date: 06/19/2020
Certification Date: 06/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 MEDICAL PARK DR
ATMORE AL
36502-3006
US

IV. Provider business mailing address

125 HOBBS CIR
ATMORE AL
36502-4850
US

V. Phone/Fax

Practice location:
  • Phone: 251-368-2500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-128241
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: