Healthcare Provider Details

I. General information

NPI: 1003242678
Provider Name (Legal Business Name): LAURA PAIGE FARRIS CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2013
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 MAIN ST UNIT 106
GRAY ME
04039-3503
US

IV. Provider business mailing address

125 20TH ST. SOUTH SUITE 103
BIRMINGHAM AL
35233
US

V. Phone/Fax

Practice location:
  • Phone: 207-317-6770
  • Fax: 207-870-4909
Mailing address:
  • Phone: 205-801-5251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-10256
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: