Provider Demographics
NPI:1720568363
Name:MOUDRY, KRISTIN (CRNP)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:MOUDRY
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 1:100 RICE MINE RD N
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35406-2300
Mailing Address - Country:US
Mailing Address - Phone:205-349-4200
Mailing Address - Fax:
Practice Address - Street 1:32 SCHOOL AVE
Practice Address - Street 2:
Practice Address - City:BERRY
Practice Address - State:AL
Practice Address - Zip Code:35546-2246
Practice Address - Country:US
Practice Address - Phone:205-689-0917
Practice Address - Fax:205-689-0949
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-14
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-122592363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily