Healthcare Provider Details

I. General information

NPI: 1477266815
Provider Name (Legal Business Name): NADIA RUSSELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NADIA TESKE

II. Dates (important events)

Enumeration Date: 12/30/2022
Last Update Date: 09/23/2025
Certification Date: 09/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1820 SOUTHPARK DR
HOOVER AL
35244-2094
US

IV. Provider business mailing address

3500 DEPAUW BLVD STE 3070
INDIANAPOLIS IN
46268-6135
US

V. Phone/Fax

Practice location:
  • Phone: 205-961-4726
  • Fax: 317-520-8200
Mailing address:
  • Phone: 855-324-0885
  • Fax: 317-520-8200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-25-82634
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: