Healthcare Provider Details

I. General information

NPI: 1053247395
Provider Name (Legal Business Name): KADEEN NICKEISHA MCELRATH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23021 MCGEHEE DR
MC CALLA AL
35111-3071
US

IV. Provider business mailing address

23021 MCGEHEE DR
MC CALLA AL
35111-3071
US

V. Phone/Fax

Practice location:
  • Phone: 205-768-3003
  • Fax:
Mailing address:
  • Phone: 205-768-3003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: