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General NPI Number Information
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NPI Number | 1558648311
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Entity Type | Organization
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Legal Business Name | VALLEY FAMILY CARE
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Dates
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Enumeration Date | 11/08/2011
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Last Update Date | 11/08/2011
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Provider Practice Location Address
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Address Line | 12060 COUNTY LINE RD SUITE D
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City | MADISON
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State | AL
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Zip | 35756-2003
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Country | US
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Telephone | 256-651-3062
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Fax |
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Provider Business Mailing Address
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Address Line | 12060 COUNTY LINE RD SUITE D
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City | MADISON
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State | AL
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Zip | 35756-2003
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Country | US
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Telephone | 256-651-3062
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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 | REBECCA RAE DICKERSON
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Credential | CRNP
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Telephone | 256-651-3062
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number | 1-093181
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License Number State | AL
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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 | 1-093181
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License Number State | AL
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