Provider Demographics
NPI:1558648311
Name:VALLEY FAMILY CARE
Entity Type:Organization
Organization Name:VALLEY FAMILY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:DICKERSON
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:256-651-3062
Mailing Address - Street 1:12060 COUNTY LINE RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35756-2003
Mailing Address - Country:US
Mailing Address - Phone:256-651-3062
Mailing Address - Fax:
Practice Address - Street 1:12060 COUNTY LINE RD
Practice Address - Street 2:SUITE D
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35756-2003
Practice Address - Country:US
Practice Address - Phone:256-651-3062
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-08
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-093181261QR1300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL110708Medicaid