Mary  E  Barry    CRNP
Contract Details
Crestwood Family Practice--Wall Triana
Facility name
Provider ID
P000008451
NPI
1104894963
Tax ID
273920921
Effective Date
5/18/2016
Last Updated
5/25/2016
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
96.00
Location Details
Address
2903 Wall Triana Highway Southwest Suite 7
Huntsville, AL 35824
United States
County
Madison
Phone
2564295248 (Phone)
Billing Details
Address
P.O. Box 689022
Franklin, TN 37068
Billing Phone
6154657000
Specialty Type
Nurse Practitioner
Map
Address