Provider Demographics
NPI:1962759050
Name:MADDOX, ALLISON NICOLE (CRNP)
Entity type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:NICOLE
Last Name:MADDOX
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 1:1174 TAYLORWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35405-5943
Mailing Address - Country:US
Mailing Address - Phone:205-887-3108
Mailing Address - Fax:
Practice Address - Street 1:3835 WATERMELON RD STE D
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:AL
Practice Address - Zip Code:35473-5003
Practice Address - Country:US
Practice Address - Phone:205-331-4904
Practice Address - Fax:205-331-4914
Is Sole Proprietor?:No
Enumeration Date:2012-08-08
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-113898363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily