Provider Demographics
NPI:1790370187
Name:SHADRICK, MAKENZIE KRAMER (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:MAKENZIE
Middle Name:KRAMER
Last Name:SHADRICK
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 1:1001 LEIGHTON AVE
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36207-5701
Mailing Address - Country:US
Mailing Address - Phone:256-237-1618
Mailing Address - Fax:256-237-2661
Practice Address - Street 1:1001 LEIGHTON AVE
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-5701
Practice Address - Country:US
Practice Address - Phone:256-237-1618
Practice Address - Fax:256-237-2661
Is Sole Proprietor?:No
Enumeration Date:2021-03-08
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL155278208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics