Healthcare Provider Details

I. General information

NPI: 1205740230
Provider Name (Legal Business Name): EDWARD BEMPONG MSN, CRNP, AGPCNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 19TH ST S
BIRMINGHAM AL
35233-1927
US

IV. Provider business mailing address

700 19TH ST S
BIRMINGHAM AL
35233-1927
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR250502
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: