Provider Demographics
NPI:1124471354
Name:SANTIAGO, KATHLEEN (CRNP)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4145 CARMICHAEL RD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-2803
Mailing Address - Country:US
Mailing Address - Phone:334-273-7000
Mailing Address - Fax:
Practice Address - Street 1:645 MCQUEEN SMITH RD N STE 207
Practice Address - Street 2:
Practice Address - City:PRATTVILLE
Practice Address - State:AL
Practice Address - Zip Code:36066-7263
Practice Address - Country:US
Practice Address - Phone:334-351-1000
Practice Address - Fax:334-273-2228
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-23
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK122593363LF0000X
AL1-104704363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily