1922393925 NPI number — DEEANN YVONNE KIZZIAH CRNP

Table of content: DEEANN YVONNE KIZZIAH CRNP (NPI 1922393925)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922393925 NPI number — DEEANN YVONNE KIZZIAH CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KIZZIAH
Provider First Name:
DEEANN
Provider Middle Name:
YVONNE
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:
1922393925
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/13/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 TOWNCENTER BLVD
Provider Second Line Business Mailing Address:
SUITE 112
Provider Business Mailing Address City Name:
TUSCALOOSA
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35406-1833
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-464-4700
Provider Business Mailing Address Fax Number:
205-343-7425

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 TOWNCENTER BLVD
Provider Second Line Business Practice Location Address:
SUITE 112
Provider Business Practice Location Address City Name:
TUSCALOOSA
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35406-1833
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-464-4700
Provider Business Practice Location Address Fax Number:
205-343-7425
Provider Enumeration Date:
06/17/2011

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:  1062800 , 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: 541003878 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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