Provider Demographics
NPI:1578002440
Name:FRENCH, DEMECHIKO (CRNP)
Entity Type:Individual
Prefix:MR
First Name:DEMECHIKO
Middle Name:
Last Name:FRENCH
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6526 IVY WALK
Mailing Address - Street 2:
Mailing Address - City:BESSEMER
Mailing Address - State:AL
Mailing Address - Zip Code:35022-1634
Mailing Address - Country:US
Mailing Address - Phone:205-420-1422
Mailing Address - Fax:
Practice Address - Street 1:1401 DOUG BAKER BLVD STE 107565
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35242-4974
Practice Address - Country:US
Practice Address - Phone:205-205-4201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-13
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2018008534363LP0808X
ALF1216314363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL256757Medicaid