=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427761865
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FULL ARMOUR HEALTH SOLUTIONS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/30/2022
-----------------------------------------------------
Last Update Date | 02/01/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 304 JACKSON STREET
-----------------------------------------------------
City | ROCKFORD
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35136-3409
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-202-4325
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 183 FAWN DR
-----------------------------------------------------
City | ROCKFORD
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35136-3409
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-397-2962
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JAMIE CHAPPELL
-----------------------------------------------------
Credential | NP
-----------------------------------------------------
Telephone | 256-397-2962
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------