Provider Demographics
NPI:1922038751
Name:CATRON, KELLEY (CRNP)
Entity Type:Individual
Prefix:
First Name:KELLEY
Middle Name:
Last Name:CATRON
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 1:3000 MEADOW LAKE DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-0301
Mailing Address - Country:US
Mailing Address - Phone:205-995-1009
Mailing Address - Fax:205-995-1049
Practice Address - Street 1:3000 MEADOW LAKE DR
Practice Address - Street 2:SUITE 101
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-0301
Practice Address - Country:US
Practice Address - Phone:205-995-1009
Practice Address - Fax:205-995-1049
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-098614363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL194186Medicaid