Provider Demographics
NPI:1558356394
Name:PRITCHETT, DINAH (CRNP)
Entity Type:Individual
Prefix:
First Name:DINAH
Middle Name:
Last Name:PRITCHETT
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1160 HEBRON RD
Mailing Address - Street 2:PO BOX 585
Mailing Address - City:GROVE HILL
Mailing Address - State:AL
Mailing Address - Zip Code:36451-5066
Mailing Address - Country:US
Mailing Address - Phone:251-275-4742
Mailing Address - Fax:
Practice Address - Street 1:295B S JACKSON ST
Practice Address - Street 2:
Practice Address - City:GROVE HILL
Practice Address - State:AL
Practice Address - Zip Code:36451-3231
Practice Address - Country:US
Practice Address - Phone:251-275-3173
Practice Address - Fax:251-275-3110
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALRX#1296363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1-064122OtherRN LICENSE
ALRX#1296OtherCRNP LICENSE
AL541003934Medicaid
AL541003934Medicaid
AL051522017Medicare ID - Type Unspecified