Provider Demographics
NPI:1053736645
Name:LACLAIR, KELLY FUTRAL (PA-C)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:FUTRAL
Last Name:LACLAIR
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:MS
Other - First Name:KELLY
Other - Middle Name:N
Other - Last Name:FUTRAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:3280 DAUPHIN STREET BLDG A
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36606-4060
Mailing Address - Country:US
Mailing Address - Phone:251-450-3700
Mailing Address - Fax:251-263-6333
Practice Address - Street 1:3280 DAUPHIN STREET BLDG A
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36606-4060
Practice Address - Country:US
Practice Address - Phone:251-450-3700
Practice Address - Fax:251-263-6333
Is Sole Proprietor?:No
Enumeration Date:2014-02-19
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2471363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant