Individual
CARLIE LAYNE PEACOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2055 E SOUTH BLVD STE 601, MONTGOMERY, AL 36116-2014
(334) 747-2999
(334) 747-7276
Mailing address
301 BROWN SPRINGS RD, MONTGOMERY, AL 36117-7005
(334) 747-4159
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
1-137124
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
212224
—
AL
01
—
512-04310
BCBS OF ALABAMA
AL
01
—
512-04312
BCBS OF ALABAMA
AL
01
—
A0001K874
MEDICARE
AL
01
—
Z54221
VIVA HEALTH
AL
Enumeration date
05/04/2017
Last updated
01/11/2023
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