Healthcare Provider Details

I. General information

NPI: 1497869556
Provider Name (Legal Business Name): BRENDA P BYNUM CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 12/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47344 US HIGHWAY 78
LINCOLN AL
35096-6748
US

IV. Provider business mailing address

47344 US HIGHWAY 78
LINCOLN AL
35096-6748
US

V. Phone/Fax

Practice location:
  • Phone: 205-763-7848
  • Fax: 205-763-7235
Mailing address:
  • Phone: 205-763-7848
  • Fax: 205-763-7235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1023344
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: