Provider Demographics
NPI:1720556509
Name:FAIN, KATIE (CRNP)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:FAIN
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 1:810 SAINT VINCENTS DR
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-1601
Mailing Address - Country:US
Mailing Address - Phone:205-939-2806
Mailing Address - Fax:205-939-2825
Practice Address - Street 1:806 SAINT VINCENTS DR STE 430
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-1684
Practice Address - Country:US
Practice Address - Phone:205-939-2806
Practice Address - Fax:205-939-2825
Is Sole Proprietor?:No
Enumeration Date:2018-11-09
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL1142232363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health