Individual
BEVIN LYLE ELLENBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
3500 HIGHWAY 78 E STE A, JASPER, AL 35501-8908
(205) 387-0333
(256) 534-2605
Mailing address
PO BOX 18428, HUNTSVILLE, AL 35804-8428
(256) 705-4224
(256) 705-4135
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
1-140234
AL
363LA2200X
Adult Health Nurse Practitioner
1-140234
AL
363LG0600X
Gerontology Nurse Practitioner
1-140234
AL
363LP2300X
Primary Care Nurse Practitioner
Primary
1-140234
AL
Other
Enumeration date
08/21/2017
Last updated
06/15/2026
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