Healthcare Provider Details

I. General information

NPI: 1437695681
Provider Name (Legal Business Name): DEBORAH LYNN MCCOLLUM FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2017
Last Update Date: 02/06/2025
Certification Date: 02/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 TAYLOR RD STE 3380
MONTGOMERY AL
36117-3587
US

IV. Provider business mailing address

55 ORCHARD TRCE
WETUMPKA AL
36093-2456
US

V. Phone/Fax

Practice location:
  • Phone: 334-242-4116
  • Fax:
Mailing address:
  • Phone: 334-202-2519
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-100626
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: