Provider Demographics
NPI:1912251166
Name:MUNSON, ALLYSON C (ARNP)
Entity type:Individual
Prefix:
First Name:ALLYSON
Middle Name:C
Last Name:MUNSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1018 RUCKER BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:ENTERPRISE
Mailing Address - State:AL
Mailing Address - Zip Code:36330-3688
Mailing Address - Country:US
Mailing Address - Phone:334-347-4343
Mailing Address - Fax:334-393-9611
Practice Address - Street 1:1018 RUCKER BLVD STE A
Practice Address - Street 2:
Practice Address - City:ENTERPRISE
Practice Address - State:AL
Practice Address - Zip Code:36330-3688
Practice Address - Country:US
Practice Address - Phone:334-347-4343
Practice Address - Fax:334-393-9611
Is Sole Proprietor?:No
Enumeration Date:2012-11-08
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-141192363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily