Provider Demographics
NPI:1821642372
Name:COLETTA, KATHRYN S (CRNP)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:S
Last Name:COLETTA
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 1:3719 DAUPHIN ST STE 100
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-1769
Mailing Address - Country:US
Mailing Address - Phone:251-410-1188
Mailing Address - Fax:
Practice Address - Street 1:100 MEMORIAL HOSPITAL DR STE 2A
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-1199
Practice Address - Country:US
Practice Address - Phone:251-343-9090
Practice Address - Fax:251-380-1015
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-01
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-138860363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care