Provider Demographics
NPI:1932732229
Name:GARRETT, KELLIE STROUD (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:KELLIE
Middle Name:STROUD
Last Name:GARRETT
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 746450
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6450
Mailing Address - Country:US
Mailing Address - Phone:251-434-3626
Mailing Address - Fax:251-445-2464
Practice Address - Street 1:1601 CENTER ST
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36604-1541
Practice Address - Country:US
Practice Address - Phone:251-660-5763
Practice Address - Fax:251-660-5752
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-15
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-138927363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty