Healthcare Provider Details

I. General information

NPI: 1902272339
Provider Name (Legal Business Name): ROSS STUART HENDRICKS C.R.N.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2015
Last Update Date: 11/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5346 STADIUM TRACE PKWY STE 100
HOOVER AL
35244-4583
US

IV. Provider business mailing address

2101 HIGHLAND AVE S STE 350
BIRMINGHAM AL
35205-4009
US

V. Phone/Fax

Practice location:
  • Phone: 205-682-8022
  • Fax: 205-682-9446
Mailing address:
  • Phone: 205-558-2517
  • Fax: 205-558-2554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number1-132974
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: