Provider Demographics
NPI:1023125119
Name:PELHAM, PAT HEATH (CRNP)
Entity type:Individual
Prefix:MS
First Name:PAT
Middle Name:HEATH
Last Name:PELHAM
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 1:314 POINCIANA DR
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-4128
Mailing Address - Country:US
Mailing Address - Phone:205-870-5139
Mailing Address - Fax:
Practice Address - Street 1:550 MONTGOMERY HWY
Practice Address - Street 2:SUITE 101
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35216-1844
Practice Address - Country:US
Practice Address - Phone:205-868-9624
Practice Address - Fax:205-868-9625
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-30135163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health