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General NPI Number Information
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NPI Number | 1538948070
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Entity Type | Organization
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Legal Business Name | COASTAL HEALTH CONNECT, LLC
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Dates
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Enumeration Date | 09/25/2023
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Last Update Date | 09/25/2023
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Provider Practice Location Address
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Address Line | 150 S INGLESIDE ST
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City | FAIRHOPE
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State | AL
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Zip | 36532-1803
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Country | US
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Telephone | 251-202-7091
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Fax |
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Provider Business Mailing Address
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Address Line | 198 PLISKA ST
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City | FAIRHOPE
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State | AL
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Zip | 36532-1926
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | MR. KELLY WILLIAM SADLER
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Credential | CRNP
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Telephone | 251-202-7091
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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