Provider Demographics
NPI:1972064400
Name:CARLISLE, NATALIE BROOKE (MD)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:BROOKE
Last Name:CARLISLE
Suffix:
Gender:F
Credentials:MD
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 989
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36533-0989
Mailing Address - Country:US
Mailing Address - Phone:251-928-0624
Mailing Address - Fax:
Practice Address - Street 1:150 S INGLESIDE ST STE 7
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-1804
Practice Address - Country:US
Practice Address - Phone:251-928-0624
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-27
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL41816208000000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program