Cora Lynn Brakhage, RDN, CDE
Individual provider Active NPI Registered Dietitian · Pell City, AL
NPI 1952963019 · NPPES record last updated Jun 28, 2019
Key facts
- NPI
- 1952963019
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Dietitian 133V00000X
- License
- 1634 (AL)
- Practice address
- 7063 Veterans Pkwy
Pell City, AL 35125-5114 - Phone
- (205) 814-2419
- Fax
- (205) 814-2429
- NPI assigned
- Jun 28, 2019
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1634 | AL | MD | Sports Medicine (Preventive Medicine) Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 1634 | AL | Yes |
Addresses
Primary practice location
7063 Veterans Pkwy
Pell City, AL 35125-5114
Mailing address
7063 Veterans Pkwy
Pell City, AL 35125-5114
Phone (205) 814-2419
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992809305 | Medicaid | AL |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | http://170.71.180.248/Citrix/SSOWeb/ | Health Information Exchange (HIE) |
Other providers in Pell City, AL
- John Michael Bowen
- Lauryn Faith Bower
- Brittany Bowlin
- Patience Riley Bradford
- Lauren Bradshaw
- Luke Brasher
- Wesley C Brown
- Bruno'S Supermarkets, LLC.
- Brigett Delisa Buice
- Cassie Burton
All providers in Pell City, AL · Registered Dietitian in Alabama
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 28, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.