Provider Demographics
NPI:1407407224
Name:BRADEN, KATIE LAUREN (CRNP)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:LAUREN
Last Name:BRADEN
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 1:2391 HIGHWAY 78
Mailing Address - Street 2:
Mailing Address - City:DORA
Mailing Address - State:AL
Mailing Address - Zip Code:35062-5233
Mailing Address - Country:US
Mailing Address - Phone:205-255-7052
Mailing Address - Fax:
Practice Address - Street 1:27 MIDWAY PLZ STE B
Practice Address - Street 2:
Practice Address - City:DORA
Practice Address - State:AL
Practice Address - Zip Code:35062-9340
Practice Address - Country:US
Practice Address - Phone:205-255-7052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-23
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-150770363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily