Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 1-135527 | AL |
N | 363LA2200X | Nurse Practitioner - Adult Health | 1-135527 | AL |
N | 363LG0600X | Nurse Practitioner - Gerontology | 1-135527 | AL |
NPI | 1073085072 |
---|---|
Provider Name | Mr. Ricky Jeremy Carwile |
First Address | Hartselle, AL 35640-3960 |
Second Address | Madison, AL 35758-9573 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/01/2019 |
Last Update Date | 02/01/2019 |