Provider Demographics
NPI:1144305053
Name:WADE, COTY DARNELL (CRNP)
Entity type:Individual
Prefix:
First Name:COTY
Middle Name:DARNELL
Last Name:WADE
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11954 FOUNDRY CIR
Mailing Address - Street 2:
Mailing Address - City:MC CALLA
Mailing Address - State:AL
Mailing Address - Zip Code:35111-2590
Mailing Address - Country:US
Mailing Address - Phone:205-938-3437
Mailing Address - Fax:
Practice Address - Street 1:195 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:AL
Practice Address - Zip Code:35042-2935
Practice Address - Country:US
Practice Address - Phone:205-926-2993
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-097913163WG0600X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0600XNursing Service ProvidersRegistered NurseGerontology