Healthcare Provider Details

I. General information

NPI: 1790691541
Provider Name (Legal Business Name): CAROLYN ANN KLUG NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 DAUPHIN ST
MOBILE AL
36606-2477
US

IV. Provider business mailing address

10175 MARCH DR N
THEODORE AL
36582-9619
US

V. Phone/Fax

Practice location:
  • Phone: 251-725-4227
  • Fax:
Mailing address:
  • Phone: 251-725-4227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number1-088955
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: