Healthcare Provider Details

I. General information

NPI: 1578150363
Provider Name (Legal Business Name): DAKIN WILL WHITE CRNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2020
Last Update Date: 12/14/2021
Certification Date: 12/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 CLOVERDALE RD
FLORENCE AL
35633-1302
US

IV. Provider business mailing address

3500 CLOVERDALE RD
FLORENCE AL
35633-1302
US

V. Phone/Fax

Practice location:
  • Phone: 256-284-7706
  • Fax: 256-284-7711
Mailing address:
  • Phone: 256-284-7706
  • Fax: 256-284-7711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-104605
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: