Healthcare Provider Details

I. General information

NPI: 1679188890
Provider Name (Legal Business Name): CHRISTOPHER DEWAYNE RODEN CRNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2020
Last Update Date: 02/01/2024
Certification Date: 09/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 BROOKWOOD MEDICAL CTR DR
BIRMINGHAM AL
35209-6804
US

IV. Provider business mailing address

2010 BROOKWOOD MEDICAL CTR DR
BIRMINGHAM AL
35209-6804
US

V. Phone/Fax

Practice location:
  • Phone: 256-436-2326
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number1-172297
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number1-172297
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number1-172297
License Number StateAL
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1-172297
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: