Healthcare Provider Details

I. General information

NPI: 1073172805
Provider Name (Legal Business Name): CONSTANCE DYAS CALLEN CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2019
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1747 OGLETREE RD STE B
AUBURN AL
36830-6648
US

IV. Provider business mailing address

1747 OGLETREE RD STE B
AUBURN AL
36830-6648
US

V. Phone/Fax

Practice location:
  • Phone: 334-787-9300
  • Fax: 334-787-9306
Mailing address:
  • Phone: 334-787-9300
  • Fax: 334-787-9306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-137962
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1-137962
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: