Basic Information
Provider Information
NPI: 1184127656
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: JONES
FirstName: JESSICA
MiddleName: M
NamePrefix:  
NameSuffix:  
Credential: CRNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2151 OLD ROCKY RIDGE ROAD
Address2: SUITE 106
City: BIRMINGHAM
State: AL
PostalCode: 352167251
CountryCode: US
TelephoneNumber: 2059891091
FaxNumber: 2059891087
Practice Location
Address1: 2010 BROOKWOOD MEDICAL CTR DR
Address2:  
City: BIRMINGHAM
State: AL
PostalCode: 352096804
CountryCode: US
TelephoneNumber: 2058772707
FaxNumber: 2058772917
Other Information
ProviderEnumerationDate: 03/12/2018
LastUpdateDate: 01/08/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 01/08/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LA2100X1-113170ALY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care

No ID Information.


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