Healthcare Provider Details

I. General information

NPI: 1962907618
Provider Name (Legal Business Name): STACI HARDY ALAM NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: STACI ANN HARDY

II. Dates (important events)

Enumeration Date: 03/26/2018
Last Update Date: 02/23/2024
Certification Date: 02/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5955 AIRPORT BLVD
MOBILE AL
36608
US

IV. Provider business mailing address

PO BOX 7987
MOBILE AL
36670-0987
US

V. Phone/Fax

Practice location:
  • Phone: 251-633-0573
  • Fax: 251-633-7367
Mailing address:
  • Phone: 251-633-7211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-094441
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: