Basic Information
| Provider Information | |||||||||
| NPI: | 1922038751 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CATRON | ||||||||
| FirstName: | KELLEY | ||||||||
| MiddleName: | |||||||||
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| Credential: | CRNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3000 MEADOW LAKE DR | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352420301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059951009 | ||||||||
| FaxNumber: | 2059951049 | ||||||||
| Practice Location | |||||||||
| Address1: | 3000 MEADOW LAKE DR | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352420301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059951009 | ||||||||
| FaxNumber: | 2059951049 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/04/2006 | ||||||||
| LastUpdateDate: | 02/02/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LW0102X | 1-098614 | AL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health |
ID Information
| ID | Type | State | Issuer | Description | 194186 | 05 | AL | MEDICAID |