Basic Information
| Provider Information | |||||||||
| NPI: | 1245741677 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PATRICK | ||||||||
| FirstName: | CARLI | ||||||||
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| Credential: | CRNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 800 SAINT VINCENTS DR STE 510 | ||||||||
| Address2: | |||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352051629 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059397100 | ||||||||
| FaxNumber: | 2059397101 | ||||||||
| Practice Location | |||||||||
| Address1: | 2700 10TH AVE SOUTH | ||||||||
| Address2: | BUILDING 2 SUITE 305 | ||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 35205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059397100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2017 | ||||||||
| LastUpdateDate: | 02/28/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 1-140628 | AL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LF0000X | 1.140628 | AL | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.