Healthcare Provider Details

I. General information

NPI: 1508459355
Provider Name (Legal Business Name): CHEYENNE MCLEMORE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2021
Last Update Date: 01/18/2023
Certification Date: 01/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 INDEPENDENCE DR
BIRMINGHAM AL
35209-5662
US

IV. Provider business mailing address

12898 JUNIORS DR
MADISON AL
35756-2844
US

V. Phone/Fax

Practice location:
  • Phone: 205-870-1273
  • Fax:
Mailing address:
  • Phone: 256-612-1024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number1-175081
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: