MEDICARE: DENISE MICHELLE ADCOCK 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	1-066157	AL

General Provider Information

NPI Number	:	1659848075
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENISE MICHELLE ADCOCK CRNP

Provider Business Mailing Address
First Line	:	170 INDEPENDENT DR
Second Line	:
City	:	RAINBOW CITY
State	:	AL
Zip	:	35906-3286
Country	:	US
Telephone Number	:	256-413-1467
Fax Number	:	256-413-1470

Provider Business Practice Location Address
First Line	:	170 INDEPENDENT DR
Second Line	:
City	:	RAINBOW CITY
State	:	AL
Zip	:	35906-3286
Country	:	US
Telephone Number	:	256-413-1467
Fax Number	:	256-413-1470

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

Provider Enumeration Date	:	10/24/2018
Last Update Date	:	10/24/2018

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Directions to “ DENISE MICHELLE ADCOCK CRNP” Practice Location

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