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General NPI Number Information
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NPI Number | 1285762344
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Entity Type | Individual
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Provider Name | FAKHRA AHMAD-BODLA N.P.
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Gender | Female
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Dates
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Enumeration Date | 03/01/2007
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Last Update Date | 10/07/2023
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Provider Practice Location Address
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Address Line | 400 SUN TEMPLE DR
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City | MADISON
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State | AL
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Zip | 35758-5924
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Country | US
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Telephone | 256-774-5524
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Fax | 256-774-5523
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Provider Business Mailing Address
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Address Line | 123 FOXHOUND DR
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City | MADISON
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State | AL
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Zip | 35758-6881
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Country | US
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Telephone | 626-644-7723
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Fax | 256-774-5523
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APN0000013314
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 14489
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 1-113025
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License Number State | AL
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