Provider Demographics
NPI:1275941601
Name:BOUTWELL, KARA ELLIOTT (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:KARA
Middle Name:ELLIOTT
Last Name:BOUTWELL
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:3 MOBILE INFIRMARY CIR
Mailing Address - Street 2:SUITE 302B
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36607-3520
Mailing Address - Country:US
Mailing Address - Phone:251-607-5400
Mailing Address - Fax:
Practice Address - Street 1:3 MOBILE INFIRMARY CIR
Practice Address - Street 2:SUITE 302B
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36607-3520
Practice Address - Country:US
Practice Address - Phone:251-607-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-29
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1073518363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL213895Medicaid
ALP02566962OtherRAILROAD MEDICARE
AL102I502361OtherMEDICARE PTAN