Healthcare Provider Details

I. General information

NPI: 1114685823
Provider Name (Legal Business Name): KATHERINE MCCRELESS CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2021
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 ACTON RD STE 110
VESTAVIA AL
35243-4248
US

IV. Provider business mailing address

2550 ACTON RD STE 110
VESTAVIA AL
35243-4248
US

V. Phone/Fax

Practice location:
  • Phone: 205-761-5196
  • Fax: 205-761-5195
Mailing address:
  • Phone: 205-761-5196
  • Fax: 205-761-5195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-145362
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: