Healthcare Provider Details

I. General information

NPI: 1720537335
Provider Name (Legal Business Name): CYNTHIA RENNE' BARRETT CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CYNTHIA RENEE' BARRETT CRNP

II. Dates (important events)

Enumeration Date: 09/23/2016
Last Update Date: 04/05/2021
Certification Date: 04/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1231 PERRY HILL ROAD SUITE C
MONTGOMERY AL
36109
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 TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-117172
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number1-117172
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code363LX0106X
TaxonomyOccupational Health Nurse Practitioner
License Number1-117172
License Number StateAL
# 4
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1-117172
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: