Healthcare Provider Details

I. General information

NPI: 1184479578
Provider Name (Legal Business Name): ADDISON HURST MORAN CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2024
Last Update Date: 09/18/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 SAINT VINCENTS DR STE 600
BIRMINGHAM AL
35205-1630
US

IV. Provider business mailing address

800 SAINT VINCENTS DR STE 600
BIRMINGHAM AL
35205-1630
US

V. Phone/Fax

Practice location:
  • Phone: 205-933-9258
  • Fax:
Mailing address:
  • Phone: 205-933-9258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number2025067928
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1-188266
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: