Provider Demographics
NPI:1871289926
Name:AVERETTE, RACHAEL CLAY
Entity type:Individual
Prefix:MRS
First Name:RACHAEL
Middle Name:CLAY
Last Name:AVERETTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4280 WATERMELON RD STE 112
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35473-5250
Mailing Address - Country:US
Mailing Address - Phone:205-750-0030
Mailing Address - Fax:
Practice Address - Street 1:4280 WATERMELON RD STE 112
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:AL
Practice Address - Zip Code:35473-5250
Practice Address - Country:US
Practice Address - Phone:205-750-0030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-12
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-168791363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner