Healthcare Provider Details

I. General information

NPI: 1740683218
Provider Name (Legal Business Name): JAMIE HIEBERT CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2014
Last Update Date: 10/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1719 6TH AVENUE SOUTH CIRC 312
BIRMINGHAM AL
35294-0001
US

IV. Provider business mailing address

1719 6TH AVENUE SOUTH CIRC 312
BIRMINGHAM AL
35294-0001
US

V. Phone/Fax

Practice location:
  • Phone: 205-975-5587
  • Fax:
Mailing address:
  • Phone: 205-975-5587
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number1-122629
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number1-122629
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: