Basic Information
| Provider Information | |||||||||
| NPI: | 1194905935 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COLEY | ||||||||
| FirstName: | ALLYSON | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | CRNP-DNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 55310 | ||||||||
| Address2: | |||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352555310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2057319701 | ||||||||
| FaxNumber: | 2052979411 | ||||||||
| Practice Location | |||||||||
| Address1: | THE KIRKLIN CLINIC | ||||||||
| Address2: | 2000 6TH AVENUE SOUTH | ||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352940001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2058018000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2007 | ||||||||
| LastUpdateDate: | 10/27/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 1-091181 | AL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 051118701 | 01 | AL | BCBS | OTHER | 051118702 | 01 | AL | BCBS | OTHER | 051118703 | 01 | AL | BCBS | OTHER | 09931885 | 05 | MS | MEDICAID | 130982 | 05 | AL | MEDICAID | 131011 | 05 | AL | MEDICAID | 131012 | 05 | AL | MEDICAID |