Provider Demographics
NPI:1902132764
Name:SHURDEN, KRISTI LYNN (FNPBC)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:LYNN
Last Name:SHURDEN
Suffix:
Gender:F
Credentials:FNPBC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49494 HIGHWAY 17
Mailing Address - Street 2:
Mailing Address - City:SULLIGENT
Mailing Address - State:AL
Mailing Address - Zip Code:35586-4454
Mailing Address - Country:US
Mailing Address - Phone:205-698-7111
Mailing Address - Fax:
Practice Address - Street 1:56 DUTCH LN
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39702-5500
Practice Address - Country:US
Practice Address - Phone:662-329-3808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-28
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-123955363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL131241Medicaid
AL131241Medicaid