Healthcare Provider Details

I. General information

NPI: 1316456726
Provider Name (Legal Business Name): DEBRA BROWN PHILLIPS CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2017
Last Update Date: 09/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2828 HIGHWAY 31 S
DECATUR AL
35603-1538
US

IV. Provider business mailing address

199 COUNTY ROAD 1294
CULLMAN AL
35058-0309
US

V. Phone/Fax

Practice location:
  • Phone: 256-353-2000
  • Fax:
Mailing address:
  • Phone: 256-338-6522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License Number1-097477
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number1-097477
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: