Healthcare Provider Details

I. General information

NPI: 1477950830
Provider Name (Legal Business Name): CARLA MELTON ROBERTS CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CARLA WILBOURN

II. Dates (important events)

Enumeration Date: 12/01/2014
Last Update Date: 03/19/2024
Certification Date: 03/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3670 GRANDVIEW PKWY # 100
BIRMINGHAM AL
35243-3326
US

IV. Provider business mailing address

5120 STONEARBOR DR
PINSON AL
35126-6417
US

V. Phone/Fax

Practice location:
  • Phone: 407-788-1906
  • Fax:
Mailing address:
  • Phone: 228-369-0184
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-078221
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: