Basic Information
| Provider Information | |||||||||
| NPI: | 1578809596 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JK HEALTH LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1904 TREE TOP LN | ||||||||
| Address2: | |||||||||
| City: | VESTAVIA | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352162811 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2053811433 | ||||||||
| FaxNumber: | 2058748333 | ||||||||
| Practice Location | |||||||||
| Address1: | 2401 COLUMBIANA RD | ||||||||
| Address2: | |||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352162580 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2058224773 | ||||||||
| FaxNumber: | 2058224255 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/19/2012 | ||||||||
| LastUpdateDate: | 12/19/2012 | ||||||||
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| AuthorizedOfficialLastName: | KIMANI | ||||||||
| AuthorizedOfficialFirstName: | JACINTA | ||||||||
| AuthorizedOfficialMiddleName: | W | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/NURSE PRACTITIONER | ||||||||
| AuthorizedOfficialTelephone: | 2053811433 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | NP-C | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 1-115537 | AL | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.