Healthcare Provider Details

I. General information

NPI: 1497200638
Provider Name (Legal Business Name): KATLIN NOLAN HANCOCK CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2016
Last Update Date: 05/26/2020
Certification Date: 05/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1722 PINE ST STE 502
MONTGOMERY AL
36106-1160
US

IV. Provider business mailing address

1722 PINE ST STE 203
MONTGOMERY AL
36106-1158
US

V. Phone/Fax

Practice location:
  • Phone: 334-293-8588
  • Fax: 334-293-6978
Mailing address:
  • Phone: 334-293-8736
  • Fax: 334-293-8738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-178364
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: