Provider Demographics
NPI:1518032002
Name:BYRUM, TIMOTHY DEWAYNE (CRNP)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:DEWAYNE
Last Name:BYRUM
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 1:720 GALLATIN STREET
Mailing Address - Street 2:SUITE 500
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-4414
Mailing Address - Country:US
Mailing Address - Phone:256-551-6510
Mailing Address - Fax:256-551-6507
Practice Address - Street 1:720 GALLATIN STREET
Practice Address - Street 2:SUITE 500
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-4414
Practice Address - Country:US
Practice Address - Phone:256-551-6510
Practice Address - Fax:256-551-6507
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-075145363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL105290Medicaid
AL891010370Medicaid
AL510I500240Medicare UPIN
ALS96474Medicare UPIN
AL891010370Medicaid