MEDICARE: DOROTHY ELLEN STIDHAM CRNP

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
1	363LF0000X	Family Nurse Practitioner	1061751	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578664652
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOROTHY ELLEN STIDHAM CRNP

Provider Business Mailing Address
First Line	:	PO BOX 2282
Second Line	:
City	:	HAMILTON
State	:	AL
Zip	:	35570-2282
Country	:	US
Telephone Number	:	205-952-9603
Fax Number	:	205-952-9661

Provider Business Practice Location Address
First Line	:	1911 MILITARY ST S
Second Line	:
City	:	HAMILTON
State	:	AL
Zip	:	35570-6611
Country	:	US
Telephone Number	:	205-952-9603
Fax Number	:	205-952-9661

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/25/2006
Last Update Date	:	08/26/2025

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