Healthcare Provider Details

I. General information

NPI: 1700264561
Provider Name (Legal Business Name): ALYSSA BROOKE LONG CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2015
Last Update Date: 05/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 6TH AVE S SUITE 9103
BIRMINGHAM AL
35233-1802
US

IV. Provider business mailing address

1700 6TH AVE S SUITE 10382
BIRMINGHAM AL
35233-1802
US

V. Phone/Fax

Practice location:
  • Phone: 205-996-3130
  • Fax: 205-996-3170
Mailing address:
  • Phone: 205-801-7807
  • Fax: 205-801-7880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number1-132925
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: