Provider Demographics
NPI:1386949873
Name:RALYEA, MISTY LAWLEY (CRNP)
Entity type:Individual
Prefix:
First Name:MISTY
Middle Name:LAWLEY
Last Name:RALYEA
Suffix:
Gender:F
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:PO BOX 11407
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35202-1407
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:47344 US HIGHWAY 78
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:AL
Practice Address - Zip Code:35096-6748
Practice Address - Country:US
Practice Address - Phone:205-763-7848
Practice Address - Fax:205-763-7235
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-14
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-081968363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily