Provider Demographics
NPI:1578500146
Name:CRANDELL, KRISTY LYNN (MD)
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:LYNN
Last Name:CRANDELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 HOSPITAL RD
Mailing Address - Street 2:
Mailing Address - City:RED BAY
Mailing Address - State:AL
Mailing Address - Zip Code:35582-3861
Mailing Address - Country:US
Mailing Address - Phone:256-356-5609
Mailing Address - Fax:256-356-5611
Practice Address - Street 1:214 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:RED BAY
Practice Address - State:AL
Practice Address - Zip Code:35582-3861
Practice Address - Country:US
Practice Address - Phone:256-356-5609
Practice Address - Fax:256-356-5611
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS19103207P00000X, 207Q00000X
AL23116207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00124582Medicaid
AL51502500OtherBC & BS OF AL
AL009957670Medicaid
MS00124582Medicaid