Healthcare Provider Details

I. General information

NPI: 1144775131
Provider Name (Legal Business Name): MICHELLE EMMONS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2016
Last Update Date: 10/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

513 BROOKWOOD BLVD STE 372
BIRMINGHAM AL
35209-7807
US

IV. Provider business mailing address

513 BROOKWOOD BLVD STE 372
BIRMINGHAM AL
35209-7807
US

V. Phone/Fax

Practice location:
  • Phone: 205-802-6595
  • Fax: 205-802-6598
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1-132105
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1-132105
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: