MEDICARE: KATHERINE E CARROLL CRNA

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	367500000X	Certified Registered Nurse Anesthetist	1-109597	AL

General Provider Information

NPI Number	:	1629357173
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE E CARROLL CRNA

Provider Business Mailing Address
First Line	:	995 9TH AVE SW
Second Line	:
City	:	BESSEMER
State	:	AL
Zip	:	35022-4527
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4511 SOUTHLAKE PKWY
Second Line	:
City	:	HOOVER
State	:	AL
Zip	:	35244-3238
Country	:	US
Telephone Number	:	334-559-5589
Fax Number	:

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

Provider Enumeration Date	:	08/15/2011
Last Update Date	:	10/11/2012

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