Provider Demographics
NPI:1821697285
Name:ANZUETO, KATHRYN WAYNE (FNP-C)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:WAYNE
Last Name:ANZUETO
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:WAYNE
Other - Last Name:GALLAGHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3463 CHAPEL LN
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35226-2135
Mailing Address - Country:US
Mailing Address - Phone:205-616-4609
Mailing Address - Fax:
Practice Address - Street 1:143 WHITE OAK TRL
Practice Address - Street 2:
Practice Address - City:WARRIOR
Practice Address - State:AL
Practice Address - Zip Code:35180-5736
Practice Address - Country:US
Practice Address - Phone:205-647-1819
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-18
Last Update Date:2023-06-28
Deactivation Date:2021-02-17
Deactivation Code:
Reactivation Date:2021-03-31
Provider Licenses
StateLicense IDTaxonomies
AL1-152220363LA2200X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health