Healthcare Provider Details

I. General information

NPI: 1396128641
Provider Name (Legal Business Name): BILLIE VAUGHAN CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2015
Last Update Date: 07/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 20TH ST S
BIRMINGHAM AL
35205-4998
US

IV. Provider business mailing address

1600 20TH ST S
BIRMINGHAM AL
35205-4998
US

V. Phone/Fax

Practice location:
  • Phone: 205-212-5600
  • Fax: 205-212-5611
Mailing address:
  • Phone: 205-212-5600
  • Fax: 205-212-5611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number1-115568
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code364SG0600X
TaxonomyGerontology Clinical Nurse Specialist
License Number1-115568
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: