Provider Demographics
NPI:1043086796
Name:MCELROY, DEDRA ANGELIC (FNP)
Entity type:Individual
Prefix:
First Name:DEDRA
Middle Name:ANGELIC
Last Name:MCELROY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 GREYHAWK CT
Mailing Address - Street 2:
Mailing Address - City:FORT MITCHELL
Mailing Address - State:AL
Mailing Address - Zip Code:36856-5422
Mailing Address - Country:US
Mailing Address - Phone:334-734-0554
Mailing Address - Fax:
Practice Address - Street 1:15 GREYHAWK CT
Practice Address - Street 2:
Practice Address - City:FORT MITCHELL
Practice Address - State:AL
Practice Address - Zip Code:36856-5422
Practice Address - Country:US
Practice Address - Phone:334-734-0554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-04
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
343900000X
AL1-166699363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)