Healthcare Provider Details

I. General information

NPI: 1982970232
Provider Name (Legal Business Name): KRISTEN NICOLE MICHAEL D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2012
Last Update Date: 03/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1179 GREENMOR DR
BESSEMER AL
35022-6445
US

IV. Provider business mailing address

995 9TH AVE SW MEDICAL STAFF OFFICE
BESSEMER AL
35022-4527
US

V. Phone/Fax

Practice location:
  • Phone: 205-481-8530
  • Fax: 205-424-6543
Mailing address:
  • Phone: 205-481-7312
  • Fax: 205-481-7593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO.1599
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberDO.1599
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: