Healthcare Provider Details

I. General information

NPI: 1295191062
Provider Name (Legal Business Name): CARLI TAYLOR CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2016
Last Update Date: 01/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14714 ST. STEPHENS AVE
CHATOM AL
36518
US

IV. Provider business mailing address

70 MIDTOWN PARK E
MOBILE AL
36606-4140
US

V. Phone/Fax

Practice location:
  • Phone: 251-544-6407
  • Fax: 251-544-6406
Mailing address:
  • Phone: 251-544-6410
  • Fax: 251-544-6411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1152005
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: