=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952850620
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EMILY BETH OLIVER CRNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/23/2016
-----------------------------------------------------
Last Update Date | 09/23/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 400 NORTHWOOD DR
-----------------------------------------------------
City | CENTRE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35960-1023
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-927-5531
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1665 COUNTY ROAD 49
-----------------------------------------------------
City | CEDAR BLUFF
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35959-4519
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-504-1094
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
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 | 1-106512
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------