Provider Demographics
NPI:1336583954
Name:WAITES, KARION GRAY (DNP)
Entity Type:Individual
Prefix:
First Name:KARION
Middle Name:GRAY
Last Name:WAITES
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 2ND AVE S
Mailing Address - Street 2:SRC 157
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35294-0113
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1717 6TH AVE S
Practice Address - Street 2:SRC 157
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35294-0113
Practice Address - Country:US
Practice Address - Phone:205-934-2785
Practice Address - Fax:205-975-4896
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-25
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-054042363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily