Provider Demographics
NPI:1841050606
Name:SUNDERMAN, KRESTA LEE (CRNP)
Entity type:Individual
Prefix:
First Name:KRESTA
Middle Name:LEE
Last Name:SUNDERMAN
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 1:434 CLYDEBANK DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-6246
Mailing Address - Country:US
Mailing Address - Phone:254-291-2178
Mailing Address - Fax:
Practice Address - Street 1:12205 COUNTY LINE RD STE C
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-7720
Practice Address - Country:US
Practice Address - Phone:256-258-8319
Practice Address - Fax:256-489-4070
Is Sole Proprietor?:No
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-173495208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics