Provider Demographics
NPI:1073172805
Name:CALLEN, CONSTANCE DYAS (CRNP)
Entity type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:DYAS
Last Name:CALLEN
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 1:1747 OGLETREE RD STE B
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36830-6648
Mailing Address - Country:US
Mailing Address - Phone:334-787-9300
Mailing Address - Fax:334-787-9306
Practice Address - Street 1:1747 OGLETREE RD STE B
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36830-6648
Practice Address - Country:US
Practice Address - Phone:334-787-9300
Practice Address - Fax:334-787-9306
Is Sole Proprietor?:No
Enumeration Date:2019-06-05
Last Update Date:2025-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-137962363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily