Provider Demographics
NPI:1346541273
Name:CROSEN, KANINA DIANE (ANP)
Entity Type:Individual
Prefix:
First Name:KANINA
Middle Name:DIANE
Last Name:CROSEN
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 SHADY LN
Mailing Address - Street 2:
Mailing Address - City:WEAVER
Mailing Address - State:AL
Mailing Address - Zip Code:36277-4544
Mailing Address - Country:US
Mailing Address - Phone:256-832-8802
Mailing Address - Fax:256-832-8877
Practice Address - Street 1:320 SNOW ST
Practice Address - Street 2:SUITE A
Practice Address - City:OXFORD
Practice Address - State:AL
Practice Address - Zip Code:36203-5401
Practice Address - Country:US
Practice Address - Phone:256-454-2569
Practice Address - Fax:256-832-8877
Is Sole Proprietor?:No
Enumeration Date:2010-11-09
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-105028363LA2200X
GARN208438363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health