Healthcare Provider Details

I. General information

NPI: 1184627002
Provider Name (Legal Business Name): TERESA BETH MCDOWELL CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PLASTICS DR
BURKVILLE AL
36752-4001
US

IV. Provider business mailing address

1093 TARILTON RD
TITUS AL
36080-3722
US

V. Phone/Fax

Practice location:
  • Phone: 334-832-5030
  • Fax: 334-832-5008
Mailing address:
  • Phone: 334-514-6911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-079531
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: