Healthcare Provider Details

I. General information

NPI: 1114654613
Provider Name (Legal Business Name): MARIA MACHELLE BRAXTON CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2022
Last Update Date: 08/04/2022
Certification Date: 08/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4305 ATLANTA HWY
MONTGOMERY AL
36109-3101
US

IV. Provider business mailing address

3700 CAHABA BEACH RD
BIRMINGHAM AL
35242-5225
US

V. Phone/Fax

Practice location:
  • Phone: 334-323-2260
  • Fax: 334-323-2265
Mailing address:
  • Phone: 205-421-2088
  • Fax: 205-278-7660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1-096102
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: