Provider Demographics
NPI:1518494020
Name:HAMMONDS, JOHN EDGAR ALAN (CRNP)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:EDGAR ALAN
Last Name:HAMMONDS
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 1:2868 ACTON RD
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA
Mailing Address - State:AL
Mailing Address - Zip Code:35243-2502
Mailing Address - Country:US
Mailing Address - Phone:205-332-3160
Mailing Address - Fax:866-702-0880
Practice Address - Street 1:5620 W THUNDERBIRD RD STE F1
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4652
Practice Address - Country:US
Practice Address - Phone:602-938-6960
Practice Address - Fax:602-938-6069
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-15
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3-001878363LP2300X
AZAP10070363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ26-0234675Medicaid