Active NPI
Dedra Angelic McElroy, FNP
- Family Nurse Practitioner
- Fort Mitchell, AL
National Provider Identifier
1043086796
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 1-166699
- Practice address
- 15 Greyhawk CT
Fort Mitchell, AL 36856-5422 - Phone
- (334) 734-0554
- NPI assigned
- Dec 4, 2023
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Non-emergency Medical Transport (VAN) | 343900000X | |||
| Family Nurse Practitioner | 363LF0000X | 1-166699 | AL | Primary |
Addresses
Primary practice location
15 Greyhawk CT
Fort Mitchell, AL 36856-5422
Mailing address
15 Greyhawk CT
Fort Mitchell, AL 36856-5422
Phone (334) 734-0554
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1-166699 | AL | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1701648000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1709078400000",
"number": "1043086796",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15 GREYHAWK CT",
"city": "FORT MITCHELL",
"state": "AL",
"postal_code": "368565422",
"telephone_number": "334-734-0554"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15 GREYHAWK CT",
"city": "FORT MITCHELL",
"state": "AL",
"postal_code": "368565422",
"telephone_number": "334-734-0554"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCELROY",
"first_name": "DEDRA",
"middle_name": "ANGELIC",
"credential": "FNP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-12-04",
"last_updated": "2024-02-28",
"certification_date": "2024-02-28",
"status": "A"
},
"taxonomies": [
{
"code": "343900000X",
"taxonomy_group": "",
"desc": "Non-emergency Medical Transport (VAN)",
"state": null,
"license": null,
"primary": false
},
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "AL",
"license": "1-166699",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Mitchell, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.