Healthcare Provider Details

I. General information

NPI: 1962829689
Provider Name (Legal Business Name): AMY BURDETTE-GRAY CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2014
Last Update Date: 03/07/2025
Certification Date: 02/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1985 AL HIGHWAY 157 STE B
CULLMAN AL
35058-1124
US

IV. Provider business mailing address

1985 AL HIGHWAY 157 STE B
CULLMAN AL
35058-1124
US

V. Phone/Fax

Practice location:
  • Phone: 256-300-2595
  • Fax: 256-302-8055
Mailing address:
  • Phone: 256-300-2595
  • Fax: 256-302-8055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-131531
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: