Provider Demographics
NPI:1902947641
Name:WHITLEY, ATALIE STEAKLEY (CRNA)
Entity Type:Individual
Prefix:
First Name:ATALIE
Middle Name:STEAKLEY
Last Name:WHITLEY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 661495
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35266-1495
Mailing Address - Country:US
Mailing Address - Phone:205-979-5882
Mailing Address - Fax:205-979-1248
Practice Address - Street 1:1112 GENE REED RD
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35235-2405
Practice Address - Country:US
Practice Address - Phone:205-836-2942
Practice Address - Fax:205-836-2946
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALRN1-097248367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
511-88848OtherBLUE CROSS BLUE SHIELD OF ALABAMA
AL1902947641OtherTRICARE
AL102I708330Medicare PIN