Individual provider Active NPI

Makena Grace Dillashaw

  • Acute Care Nurse Practitioner
  • Birmingham, AL
National Provider Identifier
1245124965
Registry record updated Jun 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
1-158332 Issued in AL
Practice address
1802 6TH Ave S # M855C
Birmingham, AL 35233-1932
Phone
(205) 934-6256
NPI assigned
Jun 6, 2025
Last updated
Jun 6, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X 1-158332 AL
Acute Care Nurse Practitioner 363LA2100X 1-158332 AL Primary

Addresses

Primary practice location

1802 6TH Ave S # M855C
Birmingham, AL 35233-1932

Mailing address

374 County Road 1651
Cullman, AL 35058-7832
Phone (256) 347-6861

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250929003327 AL Practitioner - Nurse Practitioner 7214433382 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

619 19TH St S
Birmingham, AL 35246-0001
Phone (205) 934-3460

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
1-158332ALMDAcute Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
University of Alabama Health Services Foundation, PC. CurrentSince Sep 2, 2025 Accepting new patients

Locations

5000 Medical West Way
Ste 508
Bessemer, AL 35022

1201 11th Ave S
Ste 300
Birmingham, AL 35205

1802 6th Ave S
#M855C
Birmingham, AL 35233
Phone (205) 934-6256

1813 6th Ave S
Birmingham, AL 35233
Phone (205) 934-1180

2000 6th Ave S
Birmingham, AL 35233
Phone (205) 731-9396

619 19th St S
Birmingham, AL 35233
Phone (205) 934-6405

619 19th St S
Birmingham, AL 35249

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1749168000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1749168000000",
    "number": "1245124965",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "374 COUNTY ROAD 1651",
            "city": "CULLMAN",
            "state": "AL",
            "postal_code": "350587832",
            "telephone_number": "256-347-6861"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1802 6TH AVE S # M855C",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352331932",
            "telephone_number": "205-934-6256"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DILLASHAW",
        "first_name": "MAKENA",
        "middle_name": "GRACE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-06-06",
        "last_updated": "2025-06-06",
        "certification_date": "2025-05-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "AL",
            "license": "1-158332",
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "AL",
            "license": "1-158332",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Birmingham, AL

Sources for this page

Verify at the official NPI Registry.