Healthcare Provider Details

I. General information

NPI: 1083559926
Provider Name (Legal Business Name): JESSIE DOLORES SKINN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1802 6TH AVE S
BIRMINGHAM AL
35233-1932
US

IV. Provider business mailing address

907 WILD FOREST DR
HOMEWOOD AL
35209-6752
US

V. Phone/Fax

Practice location:
  • Phone: 713-702-0073
  • Fax:
Mailing address:
  • Phone: 713-702-0073
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.2811
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: