Provider Demographics
NPI:1225175706
Name:MCCURLEY, DANETTA EMILY (CRNP)
Entity Type:Individual
Prefix:DR
First Name:DANETTA
Middle Name:EMILY
Last Name:MCCURLEY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:DANETTA
Other - Middle Name:EMILY
Other - Last Name:PORTER MCDANIEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:2269 NEW HOME RD
Mailing Address - Street 2:
Mailing Address - City:BOAZ
Mailing Address - State:AL
Mailing Address - Zip Code:35956-7159
Mailing Address - Country:US
Mailing Address - Phone:256-630-2504
Mailing Address - Fax:
Practice Address - Street 1:1502 5TH AVE SOUTH
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233
Practice Address - Country:US
Practice Address - Phone:256-623-5242
Practice Address - Fax:256-623-5243
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1099271363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51543090OtherBLUE CROSS BLUE SHIELD
AL51543086OtherBLUE CROSS BLUE SHIELD
AL51543088OtherBLUE CROSS BLUE SHIELD
AL630308047Medicaid
AL051540477OtherBLUE CROSS BLUE SHIELD
AL1099271OtherSTATE LICENSE
AL51543087OtherBLUE CROSS BLUE SHIELD
AL51543091OtherBLUE CROSS BLUE SHIELD
ALQ79016Medicare UPIN
AL051558780Medicare PIN