Healthcare Provider Details

I. General information

NPI: 1063091528
Provider Name (Legal Business Name): STACY MICHELLE LAYMON MSN, CRNP, PNPAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2021
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8490 HIGHWAY 72 W
MADISON AL
35758-9575
US

IV. Provider business mailing address

1822 CLAYTON COVE DR NW
MADISON AL
35757-7957
US

V. Phone/Fax

Practice location:
  • Phone: 256-824-3587
  • Fax:
Mailing address:
  • Phone: 937-901-7261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number1-161420
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: