Healthcare Provider Details

I. General information

NPI: 1356803266
Provider Name (Legal Business Name): KERI MALLICOAT READ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KERI ANNE MALLICOAT

II. Dates (important events)

Enumeration Date: 04/01/2019
Last Update Date: 11/17/2025
Certification Date: 11/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 HUGHES RD STE 2
MADISON AL
35758-3040
US

IV. Provider business mailing address

21 HUGHES RD STE 2
MADISON AL
35758-3040
US

V. Phone/Fax

Practice location:
  • Phone: 256-772-2037
  • Fax: 256-772-9523
Mailing address:
  • Phone: 256-772-2037
  • Fax: 256-772-9523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberAL-46133
License Number StateAL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: