Provider Demographics
NPI:1083102024
Name:BAND, KATHLEEN GRAM (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:GRAM
Last Name:BAND
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 THOMAS DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-8697
Mailing Address - Country:US
Mailing Address - Phone:256-783-9015
Mailing Address - Fax:
Practice Address - Street 1:1041 BALCH RD STE 300
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-8822
Practice Address - Country:US
Practice Address - Phone:245-325-1540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-25
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-153770363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily