Provider Demographics
NPI:1700130606
Name:CONDON, PRISCILLA THORNTON (FNP-BC)
Entity Type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:THORNTON
Last Name:CONDON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 W LAUREL AVE
Mailing Address - Street 2:
Mailing Address - City:FOLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36535-1919
Mailing Address - Country:US
Mailing Address - Phone:251-943-5885
Mailing Address - Fax:251-943-5884
Practice Address - Street 1:240 W LAUREL AVE
Practice Address - Street 2:
Practice Address - City:FOLEY
Practice Address - State:AL
Practice Address - Zip Code:36535-1919
Practice Address - Country:US
Practice Address - Phone:251-943-5885
Practice Address - Fax:251-943-5884
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-31
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALAL-1-055970163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
0156683OtherAMERICAN NURSES CREDENTIALING CENTER
AL1-055970OtherSTATE NURSING LICENSE