Healthcare Provider Details

I. General information

NPI: 1427315746
Provider Name (Legal Business Name): LETISHA S SCOTT CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2012
Last Update Date: 04/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2731 ML KING JR BLVD
TUSCALOOSA AL
35401-5235
US

IV. Provider business mailing address

2731 ML KING JR BLVD
TUSCALOOSA AL
35401-5235
US

V. Phone/Fax

Practice location:
  • Phone: 205-349-3250
  • Fax: 205-345-3993
Mailing address:
  • Phone: 205-349-3250
  • Fax: 205-345-3993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN 1-105883
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code363LC1500X
TaxonomyCommunity Health Nurse Practitioner
License NumberRN 1 105883
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: