Individual
MRS. DEIRDRE M AYCOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
45 INDUSTRIAL DR W, PINE HILL, AL 36769-3369
(334) 963-2113
(334) 963-2116
Mailing address
PO BOX 294, PINE HILL, AL 36769-0294
(334) 963-2113
(334) 963-2116
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
1-053747
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
180596
—
AL
Enumeration date
06/16/2012
Last updated
07/21/2016
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