Basic Information
Provider Information
NPI: 1972948032
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: OSBORNE
FirstName: KRISTEN
MiddleName: T
NamePrefix: MRS.
NameSuffix:  
Credential: CRNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 241947
Address2:  
City: MONTGOMERY
State: AL
PostalCode: 361241947
CountryCode: US
TelephoneNumber: 3342734508
FaxNumber: 3342734290
Practice Location
Address1: 4145 CARMICHAEL RD
Address2:  
City: MONTGOMERY
State: AL
PostalCode: 361062803
CountryCode: US
TelephoneNumber: 3342737000
FaxNumber: 3342732386
Other Information
ProviderEnumerationDate: 05/02/2013
LastUpdateDate: 05/02/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LG0600X1-118099ALY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology

No ID Information.


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