Healthcare Provider Details

I. General information

NPI: 1598023632
Provider Name (Legal Business Name): KATHRYN ASHLEY BENTLEY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2012
Last Update Date: 10/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 ST. VINCENT'S DRIVE, BLDG 3, STE 403
BIRMINGHAM AL
35205
US

IV. Provider business mailing address

833 SAINT VINCENTS DR STE 403
BIRMINGHAM AL
35205-1614
US

V. Phone/Fax

Practice location:
  • Phone: 205-939-0447
  • Fax: 205-939-0418
Mailing address:
  • Phone: 205-939-0447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number35872
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: