Healthcare Provider Details

I. General information

NPI: 1821395377
Provider Name (Legal Business Name): NATASHIA L LEDLOW CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2011
Last Update Date: 10/24/2012
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

2400 AVALON AVE
MUSCLE SHOALS AL
35661-3164
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 Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-087783
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: