Provider Demographics
NPI:1073314514
Name:AULTMAN, ADRIENNE (CRNP)
Entity type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:
Last Name:AULTMAN
Suffix:
Gender:
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1941 REDHAWK DR
Mailing Address - Street 2:
Mailing Address - City:ENTERPRISE
Mailing Address - State:AL
Mailing Address - Zip Code:36330-8055
Mailing Address - Country:US
Mailing Address - Phone:334-406-0176
Mailing Address - Fax:
Practice Address - Street 1:7125 UNIVERSITY CT
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-8016
Practice Address - Country:US
Practice Address - Phone:334-239-2622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-21
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-119367363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health