Provider Demographics
NPI:1518217876
Name:DRYER, NAKEETSHA (NP)
Entity type:Individual
Prefix:
First Name:NAKEETSHA
Middle Name:
Last Name:DRYER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 711
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-0711
Mailing Address - Country:US
Mailing Address - Phone:601-918-4866
Mailing Address - Fax:256-883-7032
Practice Address - Street 1:207 GAULT AVE S STE B
Practice Address - Street 2:
Practice Address - City:FORT PAYNE
Practice Address - State:AL
Practice Address - Zip Code:35967-1902
Practice Address - Country:US
Practice Address - Phone:256-637-3840
Practice Address - Fax:256-300-2252
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-13
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-125457363LP0808X
MSR863337363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health