MEDICARE: MRS. KATY E SHRODE CRNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	1-117191	AL

General Provider Information

NPI Number	:	1487991568
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATY E SHRODE CRNP

Provider Business Mailing Address
First Line	:	PO BOX 2705
Second Line	:
City	:	HUNTSVILLE
State	:	AL
Zip	:	35804-2705
Country	:	US
Telephone Number	:	256-265-5640
Fax Number	:	256-265-5647

Provider Business Practice Location Address
First Line	:	12205 COUNTY LINE RD STE B
Second Line	:
City	:	MADISON
State	:	AL
Zip	:	35758-7720
Country	:	US
Telephone Number	:	256-325-4365
Fax Number	:	256-461-0393

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/10/2013
Last Update Date	:	04/04/2017

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