Healthcare Provider Details

I. General information

NPI: 1922034354
Provider Name (Legal Business Name): HEATHER GREEN TALBOT CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 11/17/2024
Certification Date: 11/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 MEDICAL PARK DR
FAIRHOPE AL
36532-2083
US

IV. Provider business mailing address

2 MEDICAL PARK DR
FAIRHOPE AL
36532-2083
US

V. Phone/Fax

Practice location:
  • Phone: 251-990-6550
  • Fax: 251-990-6552
Mailing address:
  • Phone: 251-990-6550
  • Fax: 251-990-6552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number1093964
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: