Healthcare Provider Details

I. General information

NPI: 1164365052
Provider Name (Legal Business Name): ROBERT TAYLOR HENRY CRNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 DOCTORS DR
DOTHAN AL
36301-2911
US

IV. Provider business mailing address

102 DOCTORS DR
DOTHAN AL
36301-2911
US

V. Phone/Fax

Practice location:
  • Phone: 334-793-8877
  • Fax:
Mailing address:
  • Phone: 334-793-5672
  • Fax: 334-794-0378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-185020
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: