Healthcare Provider Details

I. General information

NPI: 1891116299
Provider Name (Legal Business Name): GENYCE LAVON BURKETT CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2014
Last Update Date: 01/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 LANIER ROAD
MADISON AL
35758-1866
US

IV. Provider business mailing address

2868 ACTON ROAD
BIRMINGHAM AL
35243-2502
US

V. Phone/Fax

Practice location:
  • Phone: 756-774-4500
  • Fax: 256-774-4573
Mailing address:
  • Phone: 205-968-8360
  • Fax: 205-968-8361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1-139932
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: