Doctor Name: | MRS. DEIRDRE M AYCOCK |
NPI Number: | 1588927453 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | CRNP |
License Number: | 1-053747 |
Business Practice Address: | 3945 Broad St Pine Hill, AL - 36769 |
Business Phone Number: | 3349632113 |
Business Fax Number: | 3349632116 |
Mailing Address: | Po Box 294, PINE HILL |
State: | AL |
Postal Code: | 367690294 |
Phone Number: | 3349632113 |
Fax Number: | 3349632116 |
NPI Enumeration Date: | 06/16/2012 |
NPI Last Update Date: | 03/08/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 1-053747 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AL |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |