Healthcare Provider Details

I. General information

NPI: 1861152977
Provider Name (Legal Business Name): FELICIA BRANHAM CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2021
Last Update Date: 06/06/2026
Certification Date: 06/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 BREWER ST
CORDOVA AL
35550-1256
US

IV. Provider business mailing address

PO BOX 330
CORDOVA AL
35550-0330
US

V. Phone/Fax

Practice location:
  • Phone: 205-740-7070
  • Fax:
Mailing address:
  • Phone: 205-740-7070
  • Fax: 205-740-5407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-147292
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: