Healthcare Provider Details

I. General information

NPI: 1891931192
Provider Name (Legal Business Name): SHERRY MORRIS STOUGH CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2008
Last Update Date: 12/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1608 GREAT PINE RD
BIRMINGHAM AL
35235-2819
US

IV. Provider business mailing address

1608 GREAT PINE RD
BIRMINGHAM AL
35235-2819
US

V. Phone/Fax

Practice location:
  • Phone: 205-854-2772
  • Fax: 205-854-8528
Mailing address:
  • Phone: 205-854-2772
  • Fax: 205-854-8528

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number1-033297
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: