Provider Demographics
NPI:1790910891
Name:MARTIN, MARY BETH (NP-C)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:BETH
Last Name:MARTIN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:480 WALKER DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35146-3250
Mailing Address - Country:US
Mailing Address - Phone:205-467-6919
Mailing Address - Fax:205-467-7088
Practice Address - Street 1:480 WALKER DR
Practice Address - Street 2:
Practice Address - City:SPRINGVILLE
Practice Address - State:AL
Practice Address - Zip Code:35146-3250
Practice Address - Country:US
Practice Address - Phone:205-467-6919
Practice Address - Fax:205-467-7088
Is Sole Proprietor?:No
Enumeration Date:2009-05-19
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-082199363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care