Healthcare Provider Details

I. General information

NPI: 1003795659
Provider Name (Legal Business Name): MAKENZIE COLEMAN CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2025
Last Update Date: 08/28/2025
Certification Date: 08/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 6TH AVE S
BIRMINGHAM AL
35233-2110
US

IV. Provider business mailing address

1171 TALUS RD
VESTAVIA AL
35242-2312
US

V. Phone/Fax

Practice location:
  • Phone: 205-934-3438
  • Fax:
Mailing address:
  • Phone: 601-988-4752
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number1-197725
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: