Provider Demographics
NPI:1376097113
Name:PRIDMORE, TODD K (CRNP)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:K
Last Name:PRIDMORE
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 21007
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35813-5007
Mailing Address - Country:US
Mailing Address - Phone:256-801-6056
Mailing Address - Fax:256-801-6221
Practice Address - Street 1:8371 HIGHWAY 72 W STE 204
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-9505
Practice Address - Country:US
Practice Address - Phone:256-801-5977
Practice Address - Fax:256-517-5926
Is Sole Proprietor?:No
Enumeration Date:2016-08-10
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL1-136010363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health