Healthcare Provider Details

I. General information

NPI: 1073815692
Provider Name (Legal Business Name): BOBBIE J. PACKER CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

86892 HIGHWAY 9
LINEVILLE AL
36266-6949
US

IV. Provider business mailing address

201 MONROE ST STE 1386
MONTGOMERY AL
36104-3735
US

V. Phone/Fax

Practice location:
  • Phone: 256-396-6421
  • Fax: 256-396-9172
Mailing address:
  • Phone: 334-206-7959
  • Fax: 334-206-3998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-023343
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: