Healthcare Provider Details

I. General information

NPI: 1003661315
Provider Name (Legal Business Name): COURTNEY ANN BAILEY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2024
Last Update Date: 04/19/2024
Certification Date: 04/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1802 6TH AVE S
BIRMINGHAM AL
35233-1932
US

IV. Provider business mailing address

777 CHERRYBROOK RD
KIMBERLY AL
35091-2511
US

V. Phone/Fax

Practice location:
  • Phone: 205-996-4201
  • Fax:
Mailing address:
  • Phone: 205-675-6725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1-178469
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: