1558356394 NPI number — DINAH PRITCHETT CRNP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558356394 NPI number — DINAH PRITCHETT CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PRITCHETT
Provider First Name:
DINAH
Provider Middle Name:
Provider Name Prefix Text:
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:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558356394
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/28/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1160 HEBRON RD
Provider Second Line Business Mailing Address:
PO BOX 585
Provider Business Mailing Address City Name:
GROVE HILL
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36451-5066
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
251-275-4742
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
295B S JACKSON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GROVE HILL
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36451-3231
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
251-275-3173
Provider Business Practice Location Address Fax Number:
251-275-3110
Provider Enumeration Date:
09/19/2005

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: 363L00000X , with the licence number:  RX#1296 , 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: 1-064122 . This is a "RN LICENSE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: RX#1296 . This is a "CRNP LICENSE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 541003934 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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