Healthcare Provider Details

I. General information

NPI: 1609266618
Provider Name (Legal Business Name): TABITHA SAYLOR CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TABITHA RUSH CRNP

II. Dates (important events)

Enumeration Date: 01/28/2015
Last Update Date: 01/31/2024
Certification Date: 01/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

713 GOODYEAR AVE
GADSDEN AL
35903-1156
US

IV. Provider business mailing address

713 GOODYEAR AVE
GADSDEN AL
35903-1156
US

V. Phone/Fax

Practice location:
  • Phone: 256-492-4040
  • Fax: 256-492-4017
Mailing address:
  • Phone: 256-492-4040
  • Fax: 256-492-4017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number1-110086
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1-110086
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: