Healthcare Provider Details

I. General information

NPI: 1932108826
Provider Name (Legal Business Name): JEFFERY W HERALD CRNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JEFFERY W HERALD CRNP

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 04/18/2025
Certification Date: 04/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 W SPRING ST STE 304
SYLACAUGA AL
35150-2976
US

IV. Provider business mailing address

3680 GRANDVIEW PKWY STE 200
BIRMINGHAM AL
35243-3411
US

V. Phone/Fax

Practice location:
  • Phone: 205-971-7500
  • Fax: 205-971-7571
Mailing address:
  • Phone: 205-971-7500
  • Fax: 205-971-7572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number1-059276
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: