Kaitlin Paige Gresham, CRNP
Individual provider Active NPI Family Nurse Practitioner · Red Bay, AL
NPI 1316527682 · NPPES record last updated Sep 20, 2023
Key facts
- NPI
- 1316527682
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 1-179637 (AL)
- Practice address
- 399 5TH St SE
Red Bay, AL 35582-4192 - Phone
- (256) 376-2036
- Fax
- (256) 376-2064
- NPI assigned
- Apr 12, 2021
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 2
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2020
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Bay Health and Wellness, LLC
Practice addresses (Care Compare)
399 5TH St SE
Red Bay, AL 35582-4192
Phone (256) 376-2036
Hospital & facility affiliations
- Red Bay Hospital
- Helen Keller Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230323000178 | AL | Practitioner - Nurse Practitioner | 7719351246 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1-179637 | AL | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bay Health & Wellness, LLC | Current |
Accepting new patients | |
| HH Health System - Shoals LLC | Past |
Accepting new patients |
Locations
399 5th St SE
Red Bay, AL 35582
Phone (256) 376-2036
Interoperability endpoints
- https://api.platform.athenahealth.com/20641/brand/1/csg/1/fhir/r4
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 1-179637 | AL | Yes |
Addresses
Primary practice location
399 5TH St SE
Red Bay, AL 35582-4192
Mailing address
399 5TH St SE
Red Bay, AL 35582-4192
Phone (256) 376-2036
Other providers in Red Bay, AL
- Raynard G. Fabianke
- Family Health Care Clinic, Inc.
- Devin Fancher
- Isabella Grace Fowler
- Generations of Red Bay, LLC
- Gum Creek Enterprises Inc
- HH Health System - Shoals LLC
- Kayla Marie Humphries
- Island Medical Red Bay LLC
- Keller Family Practice
All providers in Red Bay, AL · Family Nurse Practitioner in Alabama
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 20, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.