1790087112 NPI number — ANDI CARROLL FARLEY MSN,WHNP

Table of content: (NPI 1508258526)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790087112 NPI number — ANDI CARROLL FARLEY MSN,WHNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FARLEY
Provider First Name:
ANDI
Provider Middle Name:
CARROLL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSN,WHNP
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:
1790087112
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/28/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 55310
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35255-5310
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-731-9701
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1500 6TH AVE S
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:
35233-1602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-934-2170
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/18/2010

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: 363LW0102X , with the licence number:  1100927 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LW0102X , with the licence number: 1-100927 , 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: 051113236 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 051113238 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: Z50042 . This is a "VIVA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 135042 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 051113240 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 135023 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 135038 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 135024 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 135043 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 135045 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 051113235 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 051113239 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 135039 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 051113242 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 07702747 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 135046 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 051113232 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 051113233 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 051113237 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 135040 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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