Provider Demographics
NPI:1053187021
Name:HOOTEN, SHUNTAE MONTRICE (CRNP)
Entity type:Individual
Prefix:
First Name:SHUNTAE
Middle Name:MONTRICE
Last Name:HOOTEN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 AMBER LN
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35226-2101
Mailing Address - Country:US
Mailing Address - Phone:205-335-4042
Mailing Address - Fax:
Practice Address - Street 1:320 AMBER LN
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35226-2101
Practice Address - Country:US
Practice Address - Phone:205-335-4042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-30
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1151567363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily