Basic Information
Provider Information
NPI: 1124489588
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CRAVENS
FirstName: KRISTEN
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1201 11TH AVE SOUTH
Address2: UAB HIGHLANDS HOSPITAL
City: BIRMINGHAM
State: AL
PostalCode: 352053422
CountryCode: US
TelephoneNumber: 2059343411
FaxNumber:  
Practice Location
Address1: 1201 11TH AVE SOUTH
Address2: UAB HIGHLANDS HOSPITAL
City: BIRMINGHAM
State: AL
PostalCode: 352053422
CountryCode: US
TelephoneNumber: 2059343411
FaxNumber:  
Other Information
ProviderEnumerationDate: 03/14/2016
LastUpdateDate: 03/14/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LG0600X1-130188ALY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology

No ID Information.


Home