Healthcare Provider Details

I. General information

NPI: 1952803843
Provider Name (Legal Business Name): MARIA KATHLEEN CALHOUN CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2018
Last Update Date: 03/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 JACKSON TRACE RD
WETUMPKA AL
36092-1504
US

IV. Provider business mailing address

815 JACKSON TRACE RD
WETUMPKA AL
36092-1504
US

V. Phone/Fax

Practice location:
  • Phone: 334-567-2882
  • Fax: 334-567-3361
Mailing address:
  • Phone: 334-567-2882
  • Fax: 334-567-3361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number1-141132
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: