Provider Demographics
NPI:1659813228
Name:FREEMAN, CHADRICK KORTEZ (CRNP)
Entity Type:Individual
Prefix:MR
First Name:CHADRICK
Middle Name:KORTEZ
Last Name:FREEMAN
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 1:4284 LOMAC ST
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-3604
Mailing Address - Country:US
Mailing Address - Phone:334-272-6062
Mailing Address - Fax:334-272-6019
Practice Address - Street 1:4284 LOMAC ST
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106
Practice Address - Country:US
Practice Address - Phone:334-272-6062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-13
Last Update Date:2018-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-104187363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL198240Medicaid
AL511-89954OtherBLUECROSS BLUESHIELD OF ALABAMA