Healthcare Provider Details

I. General information

NPI: 1124580584
Provider Name (Legal Business Name): JESSICA NICOLE HORSLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2019
Last Update Date: 05/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 PRINCETON AVE SW STE 200A
BIRMINGHAM AL
35211-1321
US

IV. Provider business mailing address

1130 22ND ST S STE 1000
BIRMINGHAM AL
35205-2881
US

V. Phone/Fax

Practice location:
  • Phone: 57-862-7762
  • Fax: 205-786-6227
Mailing address:
  • Phone: 469-893-2065
  • Fax: 469-893-3065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number1-131576
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: