Healthcare Provider Details

I. General information

NPI: 1609646512
Provider Name (Legal Business Name): MICHELLE SCALLAN BAGGETT CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2024
Last Update Date: 01/03/2024
Certification Date: 01/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 RESEARCH BLVD STE 100
MADISON AL
35758-2176
US

IV. Provider business mailing address

247 CHATEAU DR SW
HUNTSVILLE AL
35801-6401
US

V. Phone/Fax

Practice location:
  • Phone: 256-882-1510
  • Fax: 256-217-5838
Mailing address:
  • Phone: 256-882-1510
  • Fax: 256-217-5838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1-143353
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: