Healthcare Provider Details

I. General information

NPI: 1154795177
Provider Name (Legal Business Name): CORTNEY BROWN CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2015
Last Update Date: 10/16/2024
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1653 TEMPLE AVE N STE 1
FAYETTE AL
35555-1314
US

IV. Provider business mailing address

1653 TEMPLE AVE N STE 1
FAYETTE AL
35555-1314
US

V. Phone/Fax

Practice location:
  • Phone: 205-932-1421
  • Fax: 205-932-1428
Mailing address:
  • Phone: 205-932-1421
  • Fax: 205-932-1428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-101781
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: