Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 1-048423 | AL |
NPI | 1003138678 |
---|---|
Provider Name | Judith L Cooley |
First Address | Birmingham, AL 35205-2881 |
Second Address | Gardendale, AL 35071 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2010 |
Last Update Date | 15/01/2019 |