Provider Demographics
NPI:1962106278
Name:MANN, KATHERINE (CRNP)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:MANN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:MANN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNP
Mailing Address - Street 1:PO BOX 649
Mailing Address - Street 2:
Mailing Address - City:RAINSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35986
Mailing Address - Country:US
Mailing Address - Phone:256-638-9161
Mailing Address - Fax:
Practice Address - Street 1:504 MCCURDY AVENUE S.
Practice Address - Street 2:SUITE 6
Practice Address - City:RAINSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35986
Practice Address - Country:US
Practice Address - Phone:256-638-9161
Practice Address - Fax:256-638-9164
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-29
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-174295363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily