Provider Demographics
NPI:1487197844
Name:YAZDI, COLLEEN CUSICK (CPNP-PC)
Entity Type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:CUSICK
Last Name:YAZDI
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:MS
Other - First Name:COLLEEN
Other - Middle Name:SHAE
Other - Last Name:CUSICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:500 CAHABA PARK CIR STE 100
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-8136
Mailing Address - Country:US
Mailing Address - Phone:205-848-2273
Mailing Address - Fax:
Practice Address - Street 1:500 CAHABA PARK CIR STE 100
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-8136
Practice Address - Country:US
Practice Address - Phone:205-848-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-02
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20528363LP0200X
AL1-143175363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics