Healthcare Provider Details

I. General information

NPI: 1730609553
Provider Name (Legal Business Name): AMBER MONIQUE JENNINGS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

812 CASTLEWOOD AVENUE
BIRMINGHAM AL
35206
US

IV. Provider business mailing address

812 CASTLEWOOD AVE
BIRMINGHAM AL
35206-1801
US

V. Phone/Fax

Practice location:
  • Phone: 205-706-3276
  • Fax:
Mailing address:
  • Phone: 205-706-3276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number1-148823
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: