Healthcare Provider Details

I. General information

NPI: 1801788138
Provider Name (Legal Business Name): KRISTIN SHAW SPENCER CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2025
Last Update Date: 07/21/2025
Certification Date: 07/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 RUBY TYLER PKWY
TUSCALOOSA AL
35404-2958
US

IV. Provider business mailing address

16655 OLD FAYETTE RD
NORTHPORT AL
35475-4132
US

V. Phone/Fax

Practice location:
  • Phone: 205-759-7246
  • Fax:
Mailing address:
  • Phone: 205-454-0327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-188292
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: