Healthcare Provider Details

I. General information

NPI: 1619693249
Provider Name (Legal Business Name): SERA BOBO CRNP, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2022
Last Update Date: 12/23/2025
Certification Date: 12/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 HIGHWAY 78 E STE 108
JASPER AL
35501-8968
US

IV. Provider business mailing address

4330 HIGHWAY 78 E STE 105
JASPER AL
35501-8955
US

V. Phone/Fax

Practice location:
  • Phone: 205-265-3076
  • Fax: 205-265-2235
Mailing address:
  • Phone: 205-265-3076
  • Fax: 205-265-2235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF08221310
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-169327
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: