Provider Demographics
NPI:1215978390
Name:MARTIN, KATHY TYLER (FNP)
Entity type:Individual
Prefix:MS
First Name:KATHY
Middle Name:TYLER
Last Name:MARTIN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 ST. VINCENT'S DRIVE, POB 4
Mailing Address - Street 2:SUITE 450
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-1684
Mailing Address - Country:US
Mailing Address - Phone:205-986-5200
Mailing Address - Fax:205-986-5250
Practice Address - Street 1:806 SAINT VINCENTS DR STE 450
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-1684
Practice Address - Country:US
Practice Address - Phone:205-986-5200
Practice Address - Fax:205-986-5250
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-047763363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALP23353Medicare UPIN