1225175706 NPI number — DR. DANETTA EMILY MCCURLEY CRNP

Table of content: DR. DANETTA EMILY MCCURLEY CRNP (NPI 1225175706)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225175706 NPI number — DR. DANETTA EMILY MCCURLEY CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCCURLEY
Provider First Name:
DANETTA
Provider Middle Name:
EMILY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
CRNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PORTER MCDANIEL
Provider Other First Name:
DANETTA
Provider Other Middle Name:
EMILY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CRNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1225175706
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/20/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2269 NEW HOME RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOAZ
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35956-7159
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-630-2504
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1502 5TH AVE SOUTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35233
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-623-5242
Provider Business Practice Location Address Fax Number:
256-623-5243
Provider Enumeration Date:
01/31/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  1099271 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 51543090 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51543086 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51543088 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 630308047 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 051540477 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 1099271 . This is a "STATE LICENSE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51543087 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51543091 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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