Provider Demographics
NPI:1386223238
Name:MUNCHER, MARY KAELYNN (CRNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:KAELYNN
Last Name:MUNCHER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:389 11TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:GRAYSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35073-1012
Mailing Address - Country:US
Mailing Address - Phone:205-514-4458
Mailing Address - Fax:
Practice Address - Street 1:3915 VETERANS MEMORIAL DR STE 106
Practice Address - Street 2:
Practice Address - City:ADAMSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35005-2273
Practice Address - Country:US
Practice Address - Phone:205-674-1222
Practice Address - Fax:205-674-1220
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-07
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-135419363L00000X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse