Healthcare Provider Details

I. General information

NPI: 1154781532
Provider Name (Legal Business Name): JASMINE WALKER MCQUEEN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/29/2016
Last Update Date: 11/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 6TH AVE SOUTH STD CLINIC
BIRMINGHAM AL
35233
US

IV. Provider business mailing address

PO BOX 55310
BIRMINGHAM AL
35255-5310
US

V. Phone/Fax

Practice location:
  • Phone: 205-930-1391
  • Fax:
Mailing address:
  • Phone: 205-731-9701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number1-136708
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number1-136708
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number1-136708
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: