Healthcare Provider Details

I. General information

NPI: 1427343698
Provider Name (Legal Business Name): LAYLA L RAPER CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2011
Last Update Date: 12/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

904 26TH ST
HALEYVILLE AL
35565-1719
US

IV. Provider business mailing address

904 26TH ST P.O. BOX 655
HALEYVILLE AL
35565-1719
US

V. Phone/Fax

Practice location:
  • Phone: 205-486-5234
  • Fax: 205-486-5232
Mailing address:
  • Phone: 205-486-5234
  • Fax: 205-486-5232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1-102155
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-102155
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: