Healthcare Provider Details

I. General information

NPI: 1700247145
Provider Name (Legal Business Name): MICHELLE RENEE BAGLEY CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2016
Last Update Date: 07/30/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1112 GENE REED RD
BIRMINGHAM AL
35235-2405
US

IV. Provider business mailing address

4200 COLONNADE PKWY
BIRMINGHAM AL
35243-2342
US

V. Phone/Fax

Practice location:
  • Phone: 205-836-2942
  • Fax: 205-836-2946
Mailing address:
  • Phone: 205-971-7613
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number1-114191
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number1-114191
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number1-114191
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: