Healthcare Provider Details

I. General information

NPI: 1922996651
Provider Name (Legal Business Name): MICHELLE KITCHENS CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

495 TAYLOR RD
MONTGOMERY AL
36117-3513
US

IV. Provider business mailing address

495 TAYLOR RD
MONTGOMERY AL
36117-3513
US

V. Phone/Fax

Practice location:
  • Phone: 334-279-9333
  • Fax: 334-279-9057
Mailing address:
  • Phone: 334-279-9333
  • Fax: 334-279-9057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-090967
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: