Provider Demographics
NPI:1073815692
Name:PACKER, BOBBIE J (CRNP)
Entity Type:Individual
Prefix:
First Name:BOBBIE
Middle Name:J
Last Name:PACKER
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 1:201 MONROE ST STE 1386
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36104-3735
Mailing Address - Country:US
Mailing Address - Phone:334-206-7959
Mailing Address - Fax:334-206-3998
Practice Address - Street 1:86892 HIGHWAY 9
Practice Address - Street 2:
Practice Address - City:LINEVILLE
Practice Address - State:AL
Practice Address - Zip Code:36266-6949
Practice Address - Country:US
Practice Address - Phone:256-396-6421
Practice Address - Fax:256-396-9172
Is Sole Proprietor?:No
Enumeration Date:2010-12-02
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-023343363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily