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General NPI Number Information
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NPI Number | 1407407224
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Entity Type | Individual
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Provider Name | KATIE LAUREN BRADEN CRNP
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Gender | Female
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Dates
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Enumeration Date | 09/23/2019
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Last Update Date | 11/08/2019
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Provider Practice Location Address
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Address Line | 27 MIDWAY PLZ STE B
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City | DORA
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State | AL
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Zip | 35062-9340
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Country | US
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Telephone | 205-255-7052
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Fax |
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Provider Business Mailing Address
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Address Line | 2391 HIGHWAY 78
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City | DORA
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State | AL
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Zip | 35062-5233
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Country | US
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Telephone | 205-255-7052
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 1-150770
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License Number State | AL
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