Provider Demographics
NPI:1205463338
Name:CHESTANG, MARY KATHRYN KONRAD (CRNP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:KATHRYN KONRAD
Last Name:CHESTANG
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:KATHRYN
Other - Last Name:KONRAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:800 SAINT VINCENTS DR STE 600
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-1630
Mailing Address - Country:US
Mailing Address - Phone:205-933-9258
Mailing Address - Fax:
Practice Address - Street 1:800 SAINT VINCENTS DR STE 600
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-1630
Practice Address - Country:US
Practice Address - Phone:205-933-9258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-26
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-158663363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care