Healthcare Provider Details

I. General information

NPI: 1629308168
Provider Name (Legal Business Name): CARRIE AMANDA HILL CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2010
Last Update Date: 02/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 AVALON AVE
MUSCLE SHOALS AL
35661-3164
US

IV. Provider business mailing address

PO BOX 2550
MUSCLE SHOALS AL
35662-2550
US

V. Phone/Fax

Practice location:
  • Phone: 256-386-0808
  • Fax: 256-389-8904
Mailing address:
  • Phone: 256-386-0808
  • Fax: 256-389-8904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1-093824
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: