Provider Demographics
NPI:1376219931
Name:MERCER, KATHRYN (CRNP)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:MERCER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:E
Other - Last Name:SULLIVAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:3909 MCFARLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35476-2838
Mailing Address - Country:US
Mailing Address - Phone:205-333-1993
Mailing Address - Fax:205-333-0782
Practice Address - Street 1:5005 OSCAR BAXTER DR
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35405-3698
Practice Address - Country:US
Practice Address - Phone:205-343-2225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-23
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-159478363LA2100X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1-159478OtherCRNP LICENSE