Healthcare Provider Details

I. General information

NPI: 1023601309
Provider Name (Legal Business Name): REBECCA ALEXANDER CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2021
Last Update Date: 02/17/2021
Certification Date: 02/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 MEDICAL CENTER DR
PRATTVILLE AL
36066-7288
US

IV. Provider business mailing address

1722 PINE ST STE 203
MONTGOMERY AL
36106-1158
US

V. Phone/Fax

Practice location:
  • Phone: 334-361-3090
  • Fax: 334-361-2090
Mailing address:
  • Phone: 334-293-8736
  • Fax: 334-293-8738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-154519
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: