1407190291 NPI number — MRS. MOLLY STEPHEN COWLEY ELLIOTT RN, CRNP

Table of content: MRS. MOLLY STEPHEN COWLEY ELLIOTT RN, CRNP (NPI 1407190291)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407190291 NPI number — MRS. MOLLY STEPHEN COWLEY ELLIOTT RN, CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ELLIOTT
Provider First Name:
MOLLY
Provider Middle Name:
STEPHEN COWLEY
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RN, CRNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
COWLEY
Provider Other First Name:
MOLLY
Provider Other Middle Name:
STEPHEN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
CRNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1407190291
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/12/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3686 GRANDVIEW PKWY
Provider Second Line Business Mailing Address:
SUITE 820
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35243-3407
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-971-3000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8000 LIBERTY PKWY STE 114
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VESTAVIA
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35242-7563
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-968-5988
Provider Business Practice Location Address Fax Number:
205-968-5990
Provider Enumeration Date:
11/16/2012

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:  1-132166 , 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)





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