Provider Demographics
NPI:1902305857
Name:HOOTEN, NICOLETTE WADDELL
Entity Type:Individual
Prefix:
First Name:NICOLETTE
Middle Name:WADDELL
Last Name:HOOTEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1163 EAGLE DR
Mailing Address - Street 2:
Mailing Address - City:MAYLENE
Mailing Address - State:AL
Mailing Address - Zip Code:35114-5850
Mailing Address - Country:US
Mailing Address - Phone:205-238-9900
Mailing Address - Fax:
Practice Address - Street 1:3690 GRANDVIEW PKWY
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35243-3326
Practice Address - Country:US
Practice Address - Phone:205-971-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-06
Last Update Date:2018-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-138628363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care