Healthcare Provider Details

I. General information

NPI: 1750496428
Provider Name (Legal Business Name): GAYL JULIE SPENCE FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 08/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3686 GRANDVIEW PKWY STE 710
BIRMINGHAM AL
35243-3408
US

IV. Provider business mailing address

516 QUINTARD AVE
ANNISTON AL
36201-5711
US

V. Phone/Fax

Practice location:
  • Phone: 205-723-0395
  • Fax: 205-201-6055
Mailing address:
  • Phone: 256-741-9799
  • Fax: 256-741-9795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number1-062957
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: