Healthcare Provider Details

I. General information

NPI: 1952417115
Provider Name (Legal Business Name): JENNIFER S WELDON CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 07/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

817 PRINCETON AVE SW STE 115
BIRMINGHAM AL
35211-1333
US

IV. Provider business mailing address

817 PRINCETON AVE SW STE 115
BIRMINGHAM AL
35211-1333
US

V. Phone/Fax

Practice location:
  • Phone: 205-780-1963
  • Fax: 205-780-1967
Mailing address:
  • Phone: 205-780-1963
  • Fax: 205-780-1967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number145373
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: