Healthcare Provider Details

I. General information

NPI: 1972012771
Provider Name (Legal Business Name): OCCUMED HEALTH & WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2017
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1231 PERRY HILL RD STE C
MONTGOMERY AL
36109-5206
US

IV. Provider business mailing address

PO BOX 8021
MONTGOMERY AL
36110-0021
US

V. Phone/Fax

Practice location:
  • Phone: 334-239-4957
  • Fax: 334-593-1702
Mailing address:
  • Phone: 334-239-4957
  • Fax: 334-593-1702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number1-117172
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5742
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code363LX0106X
TaxonomyOccupational Health Nurse Practitioner
License Number1-117172
License Number StateAL
# 4
Primary TaxonomyN
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number
License Number StateAL

VIII. Authorized Official

Name: MRS. CYNTHIA RENEE BARRETT
Title or Position: OWNER / CRNP
Credential: CRNP
Phone: 334-239-4957