Healthcare Provider Details

I. General information

NPI: 1952819542
Provider Name (Legal Business Name): BROOKLYN SMITHERMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2018
Last Update Date: 08/31/2021
Certification Date: 08/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6801 AIRPORT BLVD
MOBILE AL
36608-3709
US

IV. Provider business mailing address

8846 PINE RUN
SPANISH FORT AL
36527-8636
US

V. Phone/Fax

Practice location:
  • Phone: 251-633-1000
  • Fax:
Mailing address:
  • Phone: 251-802-7595
  • Fax: 251-802-7595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1-128846
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: