Provider Demographics
NPI:1659464576
Name:CALVERT, PATRICIA LEANN (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:LEANN
Last Name:CALVERT
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 1:117 SECOND AVE SE
Mailing Address - Street 2:
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35055-3511
Mailing Address - Country:US
Mailing Address - Phone:256-739-4144
Mailing Address - Fax:256-739-4595
Practice Address - Street 1:117 SECOND AVE SE
Practice Address - Street 2:
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35055-3511
Practice Address - Country:US
Practice Address - Phone:256-739-4144
Practice Address - Fax:256-739-4595
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1069394363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000031182Medicaid
AL051531182OtherBCBS