Provider Demographics
NPI:1124417159
Name:GAMPER, KATHERINE ALLEN (CRNP)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ALLEN
Last Name:GAMPER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:L
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:301 BROWN SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-7005
Mailing Address - Country:US
Mailing Address - Phone:334-273-4159
Mailing Address - Fax:334-273-4556
Practice Address - Street 1:470 TAYLOR RD STE 310
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-7130
Practice Address - Country:US
Practice Address - Phone:334-244-4322
Practice Address - Fax:334-244-4321
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-14
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-128249363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALZ69047OtherVIVA HEALTH
AL218053Medicaid
AL512-10315OtherBCBS OF ALABAMA
ALA02469AOtherMEDICARE
ALP02093706OtherRAILROAD MEDICARE