Provider Demographics
NPI:1396212239
Name:SMITH, MADELYN (CRNP, CRNA)
Entity Type:Individual
Prefix:
First Name:MADELYN
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:CRNP, CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2303 CROWNS LN
Mailing Address - Street 2:
Mailing Address - City:MOODY
Mailing Address - State:AL
Mailing Address - Zip Code:35004-3520
Mailing Address - Country:US
Mailing Address - Phone:205-382-0318
Mailing Address - Fax:
Practice Address - Street 1:619 19TH ST S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-1900
Practice Address - Country:US
Practice Address - Phone:205-934-2240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-29
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-159380363LC0200X
FLAPRN11020187367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine