Healthcare Provider Details

I. General information

NPI: 1043684822
Provider Name (Legal Business Name): CHRISTOPHER CARLSON CRNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2015
Last Update Date: 12/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 PRINCETON AVE SW
BIRMINGHAM AL
35211-1323
US

IV. Provider business mailing address

833 PRINCETON AVENUE SW POB III, SUITE 200A
BIRMINGHAM AL
35211-1323
US

V. Phone/Fax

Practice location:
  • Phone: 205-786-2776
  • Fax: 205-786-6227
Mailing address:
  • Phone: 205-786-2776
  • Fax: 205-786-6227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number1-138659
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: