Provider Demographics
NPI:1073500302
Name:CAGLE, GREGORY NEAL (CRNP)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:NEAL
Last Name:CAGLE
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1602 CHURCH ST SE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-3402
Mailing Address - Country:US
Mailing Address - Phone:256-350-1458
Mailing Address - Fax:256-350-1485
Practice Address - Street 1:1602 CHURCH ST SE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-3402
Practice Address - Country:US
Practice Address - Phone:256-350-1458
Practice Address - Fax:256-350-1485
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-088261363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51533420OtherBCBS
AL891011270Medicaid