Healthcare Provider Details

I. General information

NPI: 1013833201
Provider Name (Legal Business Name): KRISTY GENTRY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2451 UNIVERSITY HOSPITAL DR
MOBILE AL
36617-2300
US

IV. Provider business mailing address

9429 OLD HIGHWAY 43
CREOLA AL
36525-4567
US

V. Phone/Fax

Practice location:
  • Phone: 251-751-0584
  • Fax:
Mailing address:
  • Phone: 251-751-0584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number1-136895
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code163WX1500X
TaxonomyOstomy Care Registered Nurse
License Number1-136895
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1-136895
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: