Healthcare Provider Details

I. General information

NPI: 1558288712
Provider Name (Legal Business Name): SARAH BAINE GENELIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1906 GLENN BLVD SW STE 100A
FORT PAYNE AL
35968-3545
US

IV. Provider business mailing address

1906 GLENN BLVD SW STE 100A
FORT PAYNE AL
35968-3545
US

V. Phone/Fax

Practice location:
  • Phone: 256-638-4411
  • Fax:
Mailing address:
  • Phone: 256-638-4411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-150240
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: