Healthcare Provider Details

I. General information

NPI: 1255700209
Provider Name (Legal Business Name): NANCY WEBSTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NANCY TAYLOR

II. Dates (important events)

Enumeration Date: 09/21/2015
Last Update Date: 05/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2350 SCHILLINGER RD S
MOBILE AL
36695-4177
US

IV. Provider business mailing address

2350 SCHILLINGER RD S
MOBILE AL
36695-4177
US

V. Phone/Fax

Practice location:
  • Phone: 251-445-7614
  • Fax: 251-410-6127
Mailing address:
  • Phone: 251-445-7614
  • Fax: 251-410-6127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1077
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: