Provider Demographics
NPI:1255618286
Name:ALLEGOOD, NICHOLE MARTINA (FN-P)
Entity type:Individual
Prefix:
First Name:NICHOLE
Middle Name:MARTINA
Last Name:ALLEGOOD
Suffix:
Gender:F
Credentials:FN-P
Other - Prefix:
Other - First Name:NICHOLE
Other - Middle Name:MARTINA
Other - Last Name:MASON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 11407
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35246-0116
Mailing Address - Country:US
Mailing Address - Phone:256-533-7064
Mailing Address - Fax:256-704-0115
Practice Address - Street 1:201 GOVERNORS DRIVE SW
Practice Address - Street 2:STE 400
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-5183
Practice Address - Country:US
Practice Address - Phone:256-265-7246
Practice Address - Fax:256-265-7017
Is Sole Proprietor?:No
Enumeration Date:2011-11-04
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-120196363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily