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General NPI Number Information
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NPI Number | 1376097113
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Entity Type | Individual
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Provider Name | TODD K PRIDMORE CRNP
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Gender | Male
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Dates
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Enumeration Date | 08/10/2016
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Last Update Date | 05/30/2024
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Provider Practice Location Address
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Address Line | 8371 HIGHWAY 72 W STE 204
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City | MADISON
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State | AL
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Zip | 35758-9505
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Country | US
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Telephone | 256-801-5977
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Fax | 256-517-5926
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Provider Business Mailing Address
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Address Line | PO BOX 21007
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City | HUNTSVILLE
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State | AL
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Zip | 35813-5007
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Country | US
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Telephone | 256-801-6056
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Fax | 256-801-6221
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 1-136010
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License Number State | AL
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