Individual
LAURA KETTLE PENKAVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
7191 CAHABA VALLEY RD, SUITE 300, BIRMINGHAM, AL 35242-6402
(205) 995-9909
(205) 930-2063
Mailing address
323 GRAN AVE, BIRMINGHAM, AL 35209
(256) 694-4288
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
1-126161
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1-126161
CRNP
AL
Enumeration date
04/04/2013
Last updated
08/25/2015
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