Individual provider Active NPI

Elizabeth Amy Marshall, C.R.N.P.

  • Pediatric Nurse Practitioner
  • Dothan, AL
National Provider Identifier
1356332217
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
1-056378 Issued in AL
Practice address
126 Clinic Dr
Dothan, AL 36303-1980
Phone
(334) 793-1881
Fax
(334) 712-1815
NPI assigned
Oct 31, 2005
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X 1-056378 AL Primary

Addresses

Primary practice location

126 Clinic Dr
Dothan, AL 36303-1980

Mailing address

126 Clinic Dr
Dothan, AL 36303-1980
Phone (334) 793-1881

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
I20041123000475 AL Practitioner - Nurse Practitioner 4082679683 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1-056378ALMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Dothan Pediatric Clinic, P. a. Pediatrics CurrentSince Feb 1, 2016 Accepting new patients

Locations

126 Clinic Dr
Dothan, AL 36303
Phone (334) 791-1881

5565 Montgomery Hwy
Dothan, AL 36303
Phone (334) 699-3733

526 Boll Weevil Cir
Enterprise, AL 36330
Phone (334) 308-1166

323 E Barbour St
Eufaula, AL 36027
Phone (334) 619-0940

2125 W Roy Parker Rd
Ozark, AL 36360
Phone (334) 445-7337

Interoperability endpoints

  • Direct secure messaging: elizabethmarshall@dpc.allscriptsdirect.net

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.

NPI Registry JSON

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

{
    "created_epoch": "1130716800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1356332217",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "126 CLINIC DR",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363031980",
            "telephone_number": "334-793-1881",
            "fax_number": "334-712-1815"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "126 CLINIC DR",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363031980",
            "telephone_number": "334-793-1881",
            "fax_number": "334-712-1815"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARSHALL",
        "first_name": "ELIZABETH",
        "middle_name": "AMY",
        "credential": "C.R.N.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-10-31",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "AL",
            "license": "1-056378",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dothan, AL

Sources for this page

Verify at the official NPI Registry.