Healthcare Provider Details

I. General information

NPI: 1376386482
Provider Name (Legal Business Name): CORONDA POINTER ORR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2024
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 TENNESSEE ST
COURTLAND AL
35618-3357
US

IV. Provider business mailing address

PO BOX 340
MOULTON AL
35650-0340
US

V. Phone/Fax

Practice location:
  • Phone: 256-637-8033
  • Fax: 256-637-9424
Mailing address:
  • Phone: 256-637-8033
  • Fax: 256-637-9424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number1-095348
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1-095348
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: