Provider Demographics
NPI:1558880625
Name:BARBOUR, ALICIA DANIELLE (CRNP)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:DANIELLE
Last Name:BARBOUR
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 1:1241 PT MALLARD PKWY
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-6521
Mailing Address - Country:US
Mailing Address - Phone:256-286-2289
Mailing Address - Fax:
Practice Address - Street 1:1241 PT MALLARD PKWY STE 410
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-6572
Practice Address - Country:US
Practice Address - Phone:256-286-2289
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-11
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1120564363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily