Provider Demographics
NPI:1720589500
Name:DEGRANDPRE, KARI MISIAK (CRNP)
Entity Type:Individual
Prefix:
First Name:KARI
Middle Name:MISIAK
Last Name:DEGRANDPRE
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 1:2700 TRIANA BLVD SW
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35805-4046
Mailing Address - Country:US
Mailing Address - Phone:256-885-9708
Mailing Address - Fax:
Practice Address - Street 1:2700 TRIANA BLVD SW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35805-4046
Practice Address - Country:US
Practice Address - Phone:256-885-9708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-27
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-100106363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily