Individual
STACI HARDY ALAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
5955 AIRPORT BLVD, MOBILE, AL 36608
(251) 633-0573
(251) 633-7367
Mailing address
PO BOX 7987, MOBILE, AL 36670-0987
(251) 633-7211
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
1-094441
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
218235
—
AL
05
—
219701
—
AL
01
—
512-10626
BCBS
AL
01
—
512-11027
BCBS
AL
01
—
6775695
UNITED HEALTHCARE
AL
01
—
6812694
AETNA
AL
01
—
A00613A
MEDICARE
AL
01
—
P02048503
RR MEDICARE
AL
01
—
Z54594
VIVA HEALTH
AL
Enumeration date
03/26/2018
Last updated
02/23/2024
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