Provider Demographics
NPI:1134133150
Name:WEBSTER, KATHLEEN JOY (MD)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:JOY
Last Name:WEBSTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 850489
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36685-0489
Mailing Address - Country:US
Mailing Address - Phone:251-342-3949
Mailing Address - Fax:251-631-3361
Practice Address - Street 1:610 PROVIDENCE PARK DR E STE 101
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36695-4618
Practice Address - Country:US
Practice Address - Phone:251-378-3900
Practice Address - Fax:251-378-3901
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00016720207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL0410604OtherUNITED HEALTHCARE
AL000093281Medicaid
AL0005374244OtherAETNA
AL2036OtherHEALTHSPRING OF AL
AL51093281OtherBCBS OF AL
AL0410604OtherUNITED HEALTHCARE
AL000093281Medicare ID - Type Unspecified