Healthcare Provider Details

I. General information

NPI: 1609231885
Provider Name (Legal Business Name): KRISTIE L QUATTLEBAUM CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2015
Last Update Date: 03/02/2026
Certification Date: 03/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1848 PARKLAND DR NE
CULLMAN AL
35058-6100
US

IV. Provider business mailing address

171 DAY GAP RD
CULLMAN AL
35057-3372
US

V. Phone/Fax

Practice location:
  • Phone: 256-737-4101
  • Fax: 256-737-4101
Mailing address:
  • Phone: 256-531-2639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number1-133998
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number1-133998
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: