Healthcare Provider Details

I. General information

NPI: 1821737214
Provider Name (Legal Business Name): KAITLYN ELIZABETH CRONK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAITLYN ELIZABETH HICKMAN MD

II. Dates (important events)

Enumeration Date: 06/02/2022
Last Update Date: 07/24/2025
Certification Date: 07/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2451 UNIVERSITY HOSPITAL DR. MASTIN 212
MOBILE AL
36617
US

IV. Provider business mailing address

2451 UNIVERSITY HOSPITAL DR. MASTIN 212
MOBILE AL
36617
US

V. Phone/Fax

Practice location:
  • Phone: 251-471-7207
  • Fax: 251-471-7468
Mailing address:
  • Phone: 251-471-7207
  • Fax: 251-471-7468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD.51803
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: