Healthcare Provider Details

I. General information

NPI: 1710963756
Provider Name (Legal Business Name): AMY FRANKLIN CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2005
Last Update Date: 01/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 CLINIC DR
DOTHAN AL
36303-1992
US

IV. Provider business mailing address

PO BOX 8684
DOTHAN AL
36304-0684
US

V. Phone/Fax

Practice location:
  • Phone: 334-699-2229
  • Fax: 334-699-4084
Mailing address:
  • Phone: 334-699-2229
  • Fax: 334-699-4084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number1-077723
License Number StateAL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier51590097
Identifier TypeOTHER
Identifier State
Identifier IssuerBLUE CROSS OF ALABAMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: