Healthcare Provider Details

I. General information

NPI: 1962268581
Provider Name (Legal Business Name): PEYTON DIANA PURIFOY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2024
Last Update Date: 02/21/2024
Certification Date: 02/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 19TH ST S
BIRMINGHAM AL
35233-1927
US

IV. Provider business mailing address

7113 US HIGHWAY 11
SPRINGVILLE AL
35146-3807
US

V. Phone/Fax

Practice location:
  • Phone: 205-933-8101
  • Fax:
Mailing address:
  • Phone: 205-577-0718
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number1-198088
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: