Healthcare Provider Details

I. General information

NPI: 1396361051
Provider Name (Legal Business Name): MICHELLE CUMMINGS PUCKETT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2020
Last Update Date: 06/18/2020
Certification Date: 06/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 7TH AVE S
BIRMINGHAM AL
35233-1711
US

IV. Provider business mailing address

PO BOX 2328
BIRMINGHAM AL
35201-2328
US

V. Phone/Fax

Practice location:
  • Phone: 205-638-5900
  • Fax: 205-638-5920
Mailing address:
  • Phone: 256-212-5911
  • Fax: 205-212-9418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0400X
TaxonomyRehabilitation Registered Nurse
License Number1-102812
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: