Healthcare Provider Details

I. General information

NPI: 1275805202
Provider Name (Legal Business Name): LEONA CAROL ROSE CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2012
Last Update Date: 08/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1080 2ND ST
CHEROKEE AL
35616-7328
US

IV. Provider business mailing address

PO BOX 2587
MUSCLE SHOALS AL
35662-2587
US

V. Phone/Fax

Practice location:
  • Phone: 256-359-4519
  • Fax: 256-359-4516
Mailing address:
  • Phone: 256-383-4473
  • Fax: 256-381-5232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1-105688
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-105688
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: