Healthcare Provider Details

I. General information

NPI: 1275354599
Provider Name (Legal Business Name): MICAH LECROY HARTSFIELD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2024
Last Update Date: 10/19/2024
Certification Date: 10/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 SIVLEY RD SW
HUNTSVILLE AL
35801-4470
US

IV. Provider business mailing address

2700 SLATE DR SW
HUNTSVILLE AL
35803-3432
US

V. Phone/Fax

Practice location:
  • Phone: 256-265-1000
  • Fax:
Mailing address:
  • Phone: 256-458-2638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1-169461
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: