Healthcare Provider Details

I. General information

NPI: 1700470911
Provider Name (Legal Business Name): MADALINE MCCRAY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2021
Last Update Date: 12/05/2022
Certification Date: 12/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2834 MOODY PKWY
MOODY AL
35004-3101
US

IV. Provider business mailing address

536 CEDAR BROOK LN
REMLAP AL
35133-3004
US

V. Phone/Fax

Practice location:
  • Phone: 205-640-2808
  • Fax:
Mailing address:
  • Phone: 256-404-7667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-162410
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1-162410
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: