Provider Demographics
NPI:1801822374
Name:STAUTER, KELLY JEANNETTE (CRNP)
Entity type:Individual
Prefix:MS
First Name:KELLY
Middle Name:JEANNETTE
Last Name:STAUTER
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:PO BOX 40010
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36640-0010
Mailing Address - Country:US
Mailing Address - Phone:251-471-7944
Mailing Address - Fax:251-471-7451
Practice Address - Street 1:2451 FILLINGIM ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36617-2238
Practice Address - Country:US
Practice Address - Phone:251-471-7944
Practice Address - Fax:251-471-7451
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-071676363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL511-01530OtherBLUE CROSS OF AL