Individual provider Active NPI

Lillian Grace Sudduth, CRNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Florence, AL
National Provider Identifier
1356961932
Registry record updated Mar 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
1-175980 Issued in AL
Practice address
635 W College St
Florence, AL 35630-5313
Phone
(256) 768-7453
Fax
(256) 765-2036
NPI assigned
Apr 23, 2020
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 10, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 175980 AL
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 1-175980 AL Primary

Addresses

Primary practice location

635 W College St
Florence, AL 35630-5313

Mailing address

635 W College St
Florence, AL 35630-5313
Phone (256) 764-3431

Other practice location 1

1600 7th Ave S
Birmingham, AL 35233-1711
Phone (205) 638-9100

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL None

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
I20220216000118 AL Practitioner - Nurse Practitioner 5698168664 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Riverbend Center for Mental HealthGroup PAC ID 6507821048, 15 clinicians

Practice addresses (Care Compare)

635 College St W
Florence, AL 35631-5313
Phone (256) 764-3431

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
175980ALMDRegistered Nurse
1-175980ALMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Eastside Mental Health Center Inc CurrentSince Jan 31, 2022 Accepting new patients
Riverbend Center for Mental Health CurrentSince Aug 29, 2022 Accepting new patients
Eastside Mental Health Center PastSince Jan 31, 2022 Accepting new patients

Locations

129 E Park Cir
Birmingham, AL 35235
Phone (205) 836-7283

635 W College St
Florence, AL 35630
Phone (256) 764-3431

205 Jackson Ave S
Russellville, AL 35653
Phone (256) 332-3971

Organizations & group practices 3

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": "1587600000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741564800000",
    "number": "1356961932",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "635 W COLLEGE ST",
            "city": "FLORENCE",
            "state": "AL",
            "postal_code": "356305313",
            "telephone_number": "256-764-3431",
            "fax_number": "256-765-2036"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "635 W COLLEGE ST",
            "city": "FLORENCE",
            "state": "AL",
            "postal_code": "356305313",
            "telephone_number": "256-768-7453",
            "fax_number": "256-765-2036"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1600 7th Ave S",
            "address_purpose": "LOCATION",
            "city": "Birmingham",
            "state": "AL",
            "postal_code": "352331711",
            "country_code": "US",
            "telephone_number": "205-638-9100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SUDDUTH",
        "first_name": "LILLIAN",
        "middle_name": "GRACE",
        "credential": "CRNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-04-23",
        "last_updated": "2025-03-10",
        "certification_date": "2025-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "AL",
            "license": "175980",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "AL",
            "license": "1-175980",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "None",
            "affiliation": "N",
            "address_1": "1600 7th Ave S",
            "city": "Birmingham",
            "state": "AL",
            "country_code": "US",
            "postal_code": "352331711",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Florence, AL

Sources for this page

Verify at the official NPI Registry.