Healthcare Provider Details

I. General information

NPI: 1508543745
Provider Name (Legal Business Name): ASHLEY POE CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2023
Last Update Date: 06/29/2023
Certification Date: 06/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 PRINCETON AVE SW
BIRMINGHAM AL
35211-1303
US

IV. Provider business mailing address

11338 AL HIGHWAY 174
ODENVILLE AL
35120-4300
US

V. Phone/Fax

Practice location:
  • Phone: 850-723-7217
  • Fax:
Mailing address:
  • Phone: 850-723-7217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number1-169496
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: