Provider Demographics
NPI:1043516891
Name:CALVERT, STEPHANIE ALLEN (CRNP)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ALLEN
Last Name:CALVERT
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 1:1020 26TH ST S
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-2412
Mailing Address - Country:US
Mailing Address - Phone:205-332-3155
Mailing Address - Fax:205-332-3162
Practice Address - Street 1:1020 26TH ST S
Practice Address - Street 2:SUITE 100
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-2412
Practice Address - Country:US
Practice Address - Phone:205-332-3155
Practice Address - Fax:205-332-3162
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-26
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-111511363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1-111511OtherSTATE LICENSE