Provider Demographics
NPI:1386445930
Name:NALLS, IMARI JOYCEA (MSN, RN, AGACNP, RNC)
Entity type:Individual
Prefix:
First Name:IMARI
Middle Name:JOYCEA
Last Name:NALLS
Suffix:
Gender:
Credentials:MSN, RN, AGACNP, RNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12619 GILMER WAY
Mailing Address - Street 2:
Mailing Address - City:MC CALLA
Mailing Address - State:AL
Mailing Address - Zip Code:35111-2284
Mailing Address - Country:US
Mailing Address - Phone:205-862-4016
Mailing Address - Fax:
Practice Address - Street 1:12619 GILMER WAY
Practice Address - Street 2:
Practice Address - City:MC CALLA
Practice Address - State:AL
Practice Address - Zip Code:35111-2284
Practice Address - Country:US
Practice Address - Phone:205-862-4016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-20
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-177661163WN0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care