Basic Information
| Provider Information | |||||||||
| NPI: | 1821642372 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COLETTA | ||||||||
| FirstName: | KATHRYN | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | CRNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3719 DAUPHIN ST STE 100 | ||||||||
| Address2: | |||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366081769 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2514101188 | ||||||||
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| Practice Location | |||||||||
| Address1: | 100 MEMORIAL HOSPITAL DR STE 2A | ||||||||
| Address2: | |||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366081199 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2513439090 | ||||||||
| FaxNumber: | 2513801015 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/01/2019 | ||||||||
| LastUpdateDate: | 02/26/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/26/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2100X | 1-138860 | AL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
No ID Information.