Healthcare Provider Details

I. General information

NPI: 1780434050
Provider Name (Legal Business Name): DIVERSIFIED HEALTHCARE SOLUTIONS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2024
Last Update Date: 03/26/2024
Certification Date: 03/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 BOULDER DR
PIKE ROAD AL
36064-2868
US

IV. Provider business mailing address

55 BOULDER DR
PIKE ROAD AL
36064-2868
US

V. Phone/Fax

Practice location:
  • Phone: 334-294-7909
  • Fax:
Mailing address:
  • Phone: 334-294-7909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH KENDALL
Title or Position: OWNER
Credential: CRNP
Phone: 334-294-7909