Provider Demographics
NPI:1003486143
Name:BRISTER, AMY
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:BRISTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 11TH ST APT 307
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35401-3182
Mailing Address - Country:US
Mailing Address - Phone:256-683-7496
Mailing Address - Fax:
Practice Address - Street 1:708 11TH ST APT 307
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401-3182
Practice Address - Country:US
Practice Address - Phone:256-683-7496
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-30
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-140165163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine