Healthcare Provider Details

I. General information

NPI: 1699951145
Provider Name (Legal Business Name): KRISTINE LYNEA PUTMAN C.R.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2008
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1874 BELTLINE RD, SW SUITE 105
DECATUR AL
35601-5541
US

IV. Provider business mailing address

P.O. BOX 5310
DECATUR AL
35601-5541
US

V. Phone/Fax

Practice location:
  • Phone: 256-355-9711
  • Fax: 256-351-9717
Mailing address:
  • Phone: 256-355-9711
  • Fax: 256-351-9717

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-091197
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: