Provider Demographics
NPI:1346776341
Name:PRYOR, OMOTAYO ANDREA (WHNP)
Entity Type:Individual
Prefix:MRS
First Name:OMOTAYO
Middle Name:ANDREA
Last Name:PRYOR
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:OMOTAYO
Other - Middle Name:ANDREA
Other - Last Name:REESE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:252 WHITESTONE DR NE
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35810-1079
Mailing Address - Country:US
Mailing Address - Phone:256-348-2107
Mailing Address - Fax:
Practice Address - Street 1:252 WHITESTONE DR NE
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35810-1079
Practice Address - Country:US
Practice Address - Phone:256-348-2107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-11
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1114242363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health