=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588046155
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DEVIN FANCHER
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/19/2015
-----------------------------------------------------
Last Update Date | 02/20/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 221 HOSPITAL RD
-----------------------------------------------------
City | RED BAY
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35582-3858
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-376-2032
-----------------------------------------------------
Fax | 256-376-2055
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 221 HOSPITAL RD
-----------------------------------------------------
City | RED BAY
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35582-3858
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-376-2032
-----------------------------------------------------
Fax | 256-376-2055
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 1-177157
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | R891550
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------