Healthcare Provider Details

I. General information

NPI: 1639639743
Provider Name (Legal Business Name): LAYTON DON WISECARVER FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2019
Last Update Date: 01/11/2022
Certification Date: 01/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1333 MILITARY ST S
HAMILTON AL
35570-5001
US

IV. Provider business mailing address

365 EMERSON RD
HAMILTON AL
35570-8422
US

V. Phone/Fax

Practice location:
  • Phone: 205-921-3177
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1-150166
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1-150166
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number1-150166
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: