Healthcare Provider Details

I. General information

NPI: 1780504282
Provider Name (Legal Business Name): HOMEGROWN PEDIATRICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1955 LEE STREET
ROGERSVILLE AL
35652
US

IV. Provider business mailing address

227 MEADOW LN
ROGERSVILLE AL
35652-3733
US

V. Phone/Fax

Practice location:
  • Phone: 256-374-9116
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE LYNN HOFFMANN
Title or Position: OWNER
Credential:
Phone: 256-374-9116