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NPI Code Detail

MEDICARE: MELISSA CRUCE KERVIN RN

MEDICARE: MELISSA CRUCE KERVIN RN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163WG0000XGeneral Practice Registered Nurse1-185624AL
2363LP0808XPsychiatric/Mental Health Nurse Practitioner1-185624AL

General Provider Information

NPI Number : 1477240240
Entity Type Code : Individual
Provider Name (Legal Business Name) : MELISSA CRUCE KERVIN RN
Provider Business Mailing Address
First Line : 88 WOODRIDGE AVE
Second Line :
City : PIKE ROAD
State : AL
Zip : 36064-3888
Country : US
Telephone Number : 205-999-6907
Fax Number :
Provider Business Practice Location Address
First Line : 7125 UNIVERSITY CT
Second Line :
City : MONTGOMERY
State : AL
Zip : 36117-8016
Country : US
Telephone Number : 334-239-2622
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/20/2023
Last Update Date : 06/04/2026

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