Basic Information
| Provider Information | |||||||||
| NPI: | 1932584604 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BENTLEY | ||||||||
| FirstName: | KRISTEN | ||||||||
| MiddleName: | M | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 11407 | ||||||||
| Address2: | |||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352460116 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2565337064 | ||||||||
| FaxNumber: | 2567040115 | ||||||||
| Practice Location | |||||||||
| Address1: | 201 GOVERNORS DR SW STE 400 | ||||||||
| Address2: | |||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358015183 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2562657246 | ||||||||
| FaxNumber: | 2562657017 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/23/2015 | ||||||||
| LastUpdateDate: | 04/10/2018 | ||||||||
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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 | 1-113003 | AL | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health | 363LG0600X | 1-113003 | AL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology |
No ID Information.