Basic Information
| Provider Information | |||||||||
| NPI: | 1316411176 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CORSER-MCNEELY | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | LYNNE | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 7987 | ||||||||
| Address2: | |||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366700987 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2516330573 | ||||||||
| FaxNumber: | 2516337367 | ||||||||
| Practice Location | |||||||||
| Address1: | 2001 SPRING HILL AVE | ||||||||
| Address2: | |||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366073326 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2514333344 | ||||||||
| FaxNumber: | 2514334052 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/15/2019 | ||||||||
| LastUpdateDate: | 07/10/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 1-146784 | AL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 01201008 | 05 | MS | MEDICAID | 228477 | 05 | AL | MEDICAID | 229638 | 05 | AL | MEDICAID | 230307 | 05 | AL | MEDICAID | 512-22343 | 01 | AL | BCBS OF AL | OTHER | 512-22346 | 01 | AL | BCBS OF AL | OTHER | 230306 | 05 | AL | MEDICAID | 229592 | 05 | AL | MEDICAID | 512-22342 | 01 | AL | BCBS OF AL | OTHER | 512-22344 | 01 | AL | BCBS OF AL | OTHER | 512-22345 | 01 | AL | BCBS OF AL | OTHER | 6352151 | 01 | AL | AETNA | OTHER | A05462A | 01 | AL | MEDICARE | OTHER | P02224926 | 01 | AL | RR MEDICARE | OTHER | Z93605 | 01 | AL | VIVA HEALTH | OTHER |