Healthcare Provider Details

I. General information

NPI: 1487490686
Provider Name (Legal Business Name): URGENT CARE ON WHEELS 1 PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2024
Last Update Date: 09/16/2024
Certification Date: 09/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 LEE ROAD 265
CUSSETA AL
36852-2944
US

IV. Provider business mailing address

410 LEE ROAD 265
CUSSETA AL
36852-2944
US

V. Phone/Fax

Practice location:
  • Phone: 334-276-9500
  • Fax:
Mailing address:
  • Phone: 334-276-9500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MS. DONNA WHALEY
Title or Position: NURSE PRACTIONER/OWNER
Credential: NP
Phone: 334-524-0705