Healthcare Provider Details

I. General information

NPI: 1891523874
Provider Name (Legal Business Name): KRISTIN RENEE HARBIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2024
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1508 S BROAD ST STE 200
SCOTTSBORO AL
35768-2668
US

IV. Provider business mailing address

179B MOONRIDGE TRL
GURLEY AL
35748-9735
US

V. Phone/Fax

Practice location:
  • Phone: 256-259-3778
  • Fax:
Mailing address:
  • Phone: 938-666-2199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-186941
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1-186941
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: