Healthcare Provider Details

I. General information

NPI: 1477237287
Provider Name (Legal Business Name): RYLEIGH BREANNA PRICKETT AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2023
Last Update Date: 06/12/2023
Certification Date: 06/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 CORLEY AVE
BOAZ AL
35957-5952
US

IV. Provider business mailing address

602 CORLEY AVE
BOAZ AL
35957-5952
US

V. Phone/Fax

Practice location:
  • Phone: 256-571-8450
  • Fax: 256-840-4584
Mailing address:
  • Phone: 256-571-8450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number1337A
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: