Healthcare Provider Details

I. General information

NPI: 1235139155
Provider Name (Legal Business Name): SHAWNA MOFFETT CNM, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 02/08/2023
Certification Date: 02/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 HEALTH CENTER DR
CLANTON AL
35045-2349
US

IV. Provider business mailing address

4011 INDUSTRIAL PARK DR
CLANTON AL
35045-8629
US

V. Phone/Fax

Practice location:
  • Phone: 205-755-1287
  • Fax:
Mailing address:
  • Phone: 205-299-0804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-076701
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number1-076701
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: