=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992099097
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAMELA EDGEWORTH CARVER CRNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/06/2011
-----------------------------------------------------
Last Update Date | 08/02/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2801 HIGHWAY 280 S PROTECTIVE LIFE PROHEALTH
-----------------------------------------------------
City | BIRMINGHAM
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35223-2490
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-268-3265
-----------------------------------------------------
Fax | 205-268-6605
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1530 3RD AVE S SCHOOL OF NURSING LRC 381
-----------------------------------------------------
City | BIRMINGHAM
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35294-1210
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-934-7549
-----------------------------------------------------
Fax | 205-975-2501
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | 1-109633
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------